AUTHOR=Olmsted Zachary T. , Hadanny Amir , Marchese Anthony M. , DiMarzio Marisa , Khazen Olga , Argoff Charles , Sukul Vishad , Pilitsis Julie G. 

TITLE=Recommendations for Neuromodulation in Diabetic Neuropathic Pain

JOURNAL=Frontiers in Pain Research

VOLUME=Volume 2 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2021.726308

DOI=10.3389/fpain.2021.726308

ISSN=2673-561X

ABSTRACT=Over 50% of the 34 million people who suffer from diabetes mellitus (DM) are affected by diabetic neuropathy. Painful diabetic neuropathy (PDN) impacts 40-50% of that group (8.5 million patients) and is associated with a significant source of disability and economic burden. Though new neuromodulation options have been successful in recent clinical trials (NCT03228420), barriers to patient access for these therapies exist. We seek to examine our tertiary care center (Albany Medical Center) experience with PDN management by leveraging our clinical database to assess patient referral patterns and utilization of neuromodulation. We identified all patients with a diagnosis of diabetes type 1 (CODE: E10.xx) or diabetes type 2 (CODE: E11.xx) AND neuralgia/neuropathic pain (CODE: M79.2) or neuropathy (CODE:G90.09) or chronic pain (CODE: G89.4) or limb pain (CODE: M79.6) OR diabetic neuropathy (CODE: E11.4) who saw endocrinology, neurology and/or neurosurgery from 1/1/2019 to 12/31/2019. We then determined which patients had received pain medications and/or neuromodulation to divide the cohort into three groups: no treatment, conservative treatment, or neuromodulation treatment. Cohorts were compared with chi-square or one-way ANOVA with multiple comparisons to analyze differences. A total of 2,635 PDN patients were identified, of which 700 received no treatment for PDN, 1,906 received medication(s) and 29 received neuromodulation (intrathecal therapy, spinal cord stimulation, or dorsal root ganglion stimulation). Patients who received pain medications for PDN visited neurology more often than pain specialists. Of the patients that received neuromodulation, 24 had seen neurology, 6 neurology pain and 3 anesthesia pain. They averaged 2.78 pain medications prior to implant. Nearly 41% of patients in the conservative management group were prescribed 3+ medications. Of the 1,935 treated patients, only 1.5% received neuromodulation. These patients on 3+ pain medications without symptomatic relief may be potential candidates for neuromodulation. An opportunity therefore exists to educate providers on the benefits of neuromodulation procedures.