At the 2025 American Academy of Neurology (AAN) Annual Meeting in San Diego, researchers presented late-breaking data from the Inspire Study, a trial exploring spinal cord stimulation (SCS) as a holistic treatment for painful diabetic peripheral neuropathy (pDPN). The findings suggest that SCS may significantly reduce pain and autonomic symptoms while promoting neurological recovery in this hard-to-treat population.
Painful diabetic peripheral neuropathy is often resistant to conventional medications, leaving patients with persistent pain and functional limitations. The Inspire Study enrolled individuals with the classical “stocking-and-glove” distribution of pDPN pain, primarily affecting their lower limbs. Participants underwent SCS using a 4-port system with percutaneous leads targeting both thoracic (T10–T12) and cervical (C5–T1) spinal levels.
Among 11 implanted participants, 8 reached the ~8-month follow-up. These individuals reported substantial improvements in multiple domains. Lower limb pain scores dropped from a baseline of 8.6 to 1.7 on the Visual Analog Scale (VAS), and upper limb pain decreased from 6.2 to 1.1. Neuropathic symptoms also improved, with Neuropathic Pain Symptom Inventory (NPSI) scores decreasing from 43 to 8 (p<0.05). Importantly, autonomic symptoms, often overlooked in pDPN, were also alleviated. Patients reported significant reductions in orthostatic, sexual, and pupillomotor dysfunction, with BASQ scores improving from 27.9 to 16.7 (p=0.018). Objective neurological testing showed gains in both large- and small-fiber function. Exam scores (UENS) improved from 21 to 13 (p=0.027), while thermography and skin conductance data pointed to enhanced sudomotor performance. The findings suggest that SCS may not only relieve pain but also contribute to broader sensory and autonomic recovery in pDPN. While the sample size remains small, the results from the Inspire Study offer early evidence supporting a multifaceted neuromodulation approach to a complex and disabling condition. Reference: Gutierrez G et al. A Holistic Spinal Cord Stimulation Approach To Treat Painful Diabetic Peripheral Neuropathy: The Inspire Study. 2025 American Academy of Neurology (AAN) Annual Meeting, April 5-9, 2025, San Diego, California, USA.
