Diabetic neuropathy can produce a difficult combination of symptoms: burning or shooting pain alongside numbness and reduced awareness of temperature or touch.
Relieving the pain does not necessarily restore the sensation that helps someone notice an injury.
A trial of high-frequency spinal cord stimulation has now reported improvements in both pain and sensory function, offering a potentially useful option for people whose symptoms have resisted conventional treatment.
The study involved 91 adults across 13 US centres.
Participants received either conventional medical management alone or that treatment alongside spinal cord stimulation.
The treatment uses an implanted system to deliver electrical stimulation near the spinal cord.
It is a specialist procedure, rather than a wearable device or something patients can try themselves.
In the trial’s conservative analysis, 27 of the 34 participants who underwent a temporary stimulation trial achieved at least 50% pain relief, compared with two of 50 receiving conventional care alone.
The sensory findings were also notable.
Among participants with six-month results, meaningful improvement was recorded in 55.2% of the stimulation group, compared with 25% of the conventional-care group.
Skin samples showed an increase in small nerve-fibre density, but that does not establish lasting nerve regeneration or prove the underlying disease had been reversed.
There are reasons to be cautious about the size of the benefit.
Participants knew which treatment they received, although sensory assessors were blinded, and the trial stopped early after meeting its effectiveness criteria.
The study was also funded by Nevro, the manufacturer of the system, and focused on severe, treatment-resistant neuropathy rather than milder symptoms.
For readers dealing with persistent nerve pain, the immediate implication is that unsuccessful treatment should lead to a review, not an assumption that nothing else can help.
NHS guidance notes that neuropathic pain often needs medicines other than ordinary painkillers, and that another treatment may help when the first does not. Managing the underlying diabetes remains important too.
Spinal cord stimulation adds to that discussion for selected patients. Whether its sensory effects endure, and whether they reduce problems such as foot injuries, will require longer follow-up.