This prospective cohort study aimed to investigate whether individuals with painful diabetic peripheral neuropathy (PDN), treated with high-frequency spinal cord stimulation (SCS), experience enhancements in peripheral nerve function in the lower extremities.

Patients diagnosed with PDN underwent treatment with high-frequency SCS and were monitored for 12 months post-implantation. Clinical outcomes, encompassing pain severity, neuropathic symptoms, and neurological function, were examined. Utilizing the quantitative sudomotor axon reflex test (QSART), the small-fiber sudomotor function was evaluated. On the other hand, large-fiber function was analyzed through nerve conduction studies. Laser doppler flowmetry was employed to estimate lower-extremity perfusion.

Overall, 9 subjects completed the twelve-month follow-up and exhibited improvements in lower-extremity pain, positive sensory symptoms, and weakness. Neuropathy impairment scores showed enhancement, and two patients demonstrated recovery of sensory responses in nerve conduction studies. A decrease in sweat volume was observed in the proximal leg during the QSART, while no such reduction occurred at other locations. No profound differences were reported in lower-extremity perfusion or nerve conduction studies compared to baseline.

The alleviation of pain corresponded with improvements in neuropathy symptoms. While this study offered promising initial data supporting the hypothesis of a positive impact of SCS on peripheral neuropathy, the findings were based on a small sample size and necessitated additional investigations.