Neuromodulation and Painful Diabetic Neuropathy: What the Research Reveals
A poster presented at the 2025 American Society of Podiatric Surgeons’ Annual Conference took a closer look at two techniques that address painful diabetic neuropathy. Allison Abrishami, BA; Anjali Mahatpure MMS; Justin Martinez MBS; and Edgar Sy, DPM, AACFAS, at the Barry University School of Podiatric Medicine, set out to learn more about pain relief and other potential benefits of two neuromodulation techniques in their work, “Comparative Analysis of Peripheral Nerve Stimulation vs. Spinal Cord Stimulation for Painful Diabetic Neuropathy.”
“Our main goal was to determine which approach offers the most effective, lasting, and accessible relief. As neuromodulation advances, it’s exciting to see how individualized therapy, balancing efficacy, invasiveness, and patient needs, can truly transform outcomes for those living with chronic pain,” said Student Doctor Abrishami.
The research team performed a narrative-based comparative review of 4 peer-reviewed studies published within the past ten years. Two studies focused on high-frequency (10 kHz) spinal cord stimulation (SCS), while the other 2 examined peripheral nerve stimulation (PNS) and magnetic peripheral nerve stimulation (mPNS). Across all studies, pain reduction was measured using the visual analog scale (VAS), with secondary outcomes including hemoglobin A1c (HbA1c), weight change, sleep quality, and opioid consumption (measured in morphine milligram equivalents, MME). The analysis evaluated both short- and long-term outcomes to better understand the clinical impact of each modality.
“All 4 studies highlighted the remarkable potential of neuromodulation to transform care for patients suffering from painful diabetic neuropathy,” shared Student Doctor Justin Martinez. High-frequency (10 kHz) spinal cord stimulation demonstrated sustained pain reduction of over 80% through 24 months, along with meaningful systemic improvements in glycemic control, weight management, and sleep quality. He mentions that peripheral nerve stimulation, including magnetic PNS, produced impressive early pain relief of up to 87% at 3 months, showing great promise as a minimally invasive option, though the studies suggested some reduction in efficacy over time.
“Collectively, these findings suggest that while spinal cord stimulation offers broader and longer-lasting benefits, peripheral nerve stimulation stands out as a cost-effective, accessible therapy that can be integrated directly into podiatric practice,” noted Student Doctor Anjali Mahatpure. “For podiatric surgeons, this represents an incredible opportunity to expand the scope of care and play a leading role in advancing neuromodulation treatments that restore comfort, mobility, and quality of life for patients with diabetic neuropathy.”
