Long-Term Outcomes, Durability, and Future Directions

Painful diabetic peripheral neuropathy (PDPN) is among the most common and disabling complications of diabetes mellitus and remains a significant source of chronic neuropathic pain, impaired function, sleep disturbance, and reduced quality of life. Despite widespread use of anticonvulsants, antidepressants, and opioid-based therapies, many patients continue to experience refractory pain with limited long-term benefit. Recent advances in spinal cord stimulation (SCS) have transformed the treatment landscape for PDPN. Randomized clinical trials, including SENZA-PDN, have demonstrated substantial improvements in pain reduction, neurologic function, sleep quality, and patient-reported outcomes among appropriately selected patients. As evidence supporting neuromodulation continues to expand, clinicians increasingly face questions regarding patient selection, timing of referral, durability of benefit, and practical implementation within multidisciplinary diabetes care. This session will review the evolving evidence base supporting SCS for PDPN, including randomized controlled trials, long-term follow-up data, and emerging real-world outcomes. Faculty will discuss mechanisms underlying neuromodulation in diabetic neuropathy, identify appropriate patient selection criteria, and examine implementation strategies for integrating SCS into routine clinical practice. Long-term outcomes, durability, cost-effectiveness, and future directions in neuromodulation for PDPN will also be addressed. Through expert-led presentations and case-based discussion, attendees will gain a practical framework for evaluating spinal cord stimulation as a therapeutic option for patients with refractory painful diabetic neuropathy.