Painful diabetic neuropathy (PDN) remains challenging to manage despite available pharmacologic therapies, leading to growing interest in neuromodulation approaches. A systematic review and meta-analysis published in Pain Research and Management evaluated the efficacy and safety of high-frequency spinal cord stimulation (HF-SCS) and low-frequency spinal cord stimulation (LF-SCS) in adults with PDN.

The review included studies published between 2015 and 2024 involving adults with PDN treated with either HF-SCS or LF-SCS. Outcomes included pain intensity measured using visual analog scale scores, quality of life assessed with EQ-5D, and adverse events. Data from eligible studies were pooled using random-effects meta-analysis models, and subgroup analyses were performed to evaluate heterogeneity.

Findings

• Nine studies involving 416 participants met eligibility criteria.
• Randomized controlled trials demonstrated that spinal cord stimulation reduced pain intensity at 6 months compared with best medical therapy, with an overall mean difference of −3.95 on a 0-10 pain scale.
• Subgroup analyses demonstrated larger pain reductions in HF-SCS trials (mean difference −5.20) than in LF-SCS trials (mean difference −3.22).
• Both HF-SCS and LF-SCS demonstrated low adverse event rates, with most complications related to implanted devices.
• Quality-of-life improvements measured using EQ-5D were modest and did not consistently exceed prespecified minimal important difference thresholds.

The analysis demonstrated substantial pain reduction with both HF-SCS and LF-SCS in adults with PDN, although overall certainty of evidence remained moderate at best. Because no direct head-to-head trials were available, indirect comparisons between stimulation modalities should be interpreted cautiously.