1083 Assessing the Efficacy of Spinal Cord Stimulation in Managing Painful Diabetic Neuropathy: A Meta-Analysis

INTRODUCTION: Diabetes Mellitus (DM) often leads to diabetic neuropathy (DN), particularly Diabetic Peripheral Neuropathy (DPN), causing significant pain and discomfort. Despite available pharmacological treatments, many patients remain untreated or experience intolerable side effects. METHODS: A comprehensive search strategy was implemented through March 26, 2024, across five databases (PubMed, Scopus, WOS, Embase, and Cochrane CENTRAL), identifying studies relevant to SCC and PDN. Eligibility criteria included all clinical trials reporting teh safey and efficacy of SCS in PDN patients. The screening and data extraction were done by two independent reviewers. Risk of bias assessment was done by ROBINS-I or RoB 2.0 tool. Statistical analysis involved narrative synthesis and meta-analysis. Subgroup analyses and leave-one-out analyses were performed. RESULTS: The mean difference (MD) in pain intensity between the SCS and best medical therapy (BMT) groups after six months was -4.82 (95% CI: [-6.42, -3.22], p < 0.00001), favoring the SCS group. Treatment success, defined as achieving =50% pain relief, was significantly higher in the SCS group with a risk difference (RD) of 0.59 (95% CI: [0.33, 0.85], p < 0.00001) compared to BMT group. Additionally, SCS led to a significant improvement in quality of life measures compared to BMT group, with an MD of 0.16 (95% CI: [0.10, 0.23], p < 0.00001) for EQ-5D utility index and an MD of 15.29 (95% CI: [4.51, 26.07], p = 0.005) for self-reported health. Adverse events related to SCS implantation were generally low. CONCLUSIONS: SCS shows promise as an effective treatment option for painful PDN, offering significant pain relief, improved treatment success, and enhanced quality of life. Despite some heterogeneity and limitations in the current evidence. Further high-quality trials, including comparisons between different SCS modalities, are recommended to validate these findings and optimize treatment approaches for painful PDN patients.