Spinal Cord Stimulation Improves Pain and Quality of Life in Painful Diabetic Neuropathy: A Meta-Analysis of Randomized Trials.

OBJECTIVES

This study aimed to evaluate whether spinal cord stimulation (SCS) improves pain and patient-centered outcomes compared with conventional medical management in adults with painful diabetic neuropathy (PDN), and to synthesize evidence from randomized controlled trials (RCTs) regarding efficacy and safety.

MATERIALS AND

METHODS

A systematic search of PubMed, Scopus, Cochrane Library, Embase, and Google Scholar was conducted from inception through December 2025. Eligible studies were RCTs enrolling adults with diabetes and PDN that compared SCS combined with conventional medical management with conventional medical management alone. Outcomes included pain intensity, ≥ 50% pain relief, quality of life (QOL), sleep quality, and complications. Data were pooled using Review Manager 5.4. Mean differences (MD) were used for continuous outcomes and risk ratios (RR) for dichotomous outcomes, each with 95% confidence intervals (CIs). Random-effects models were used for the primary analyses, given the anticipated clinical and methodological heterogeneity across studies.

RESULTS

Seven RCTs were included in the qualitative synthesis and 3 RCTs were included in the quantitative synthesis. Compared with conventional therapy alone, SCS was associated with significant improvements in pain intensity (MD 4.09, 95% CI 2.58-5.59; p < 0.001) and QOL (MD -0.17; p < 0.001). A higher proportion of patients achieved pain relief (RR 0.11; p < 0.001), favoring SCS. No statistically significant differences were observed in sleep quality or complication rates between groups (p > 0.05).

CONCLUSIONS

In adults with refractory PDN, SCS was associated with clinically meaningful improvements in pain and QOL without an observed increase in adverse events. These findings suggest a potential role of SCS as an adjunct to conventional medical management, while further trials are needed to clarify long-term neurological, limb-related, and realworld effectiveness outcomes.