Spinal Cord Stimulation: Overview, How It’s Done, Benefits

The term spinal cord stimulation – a common treatment for painful diabetic peripheral neuropathy – may sound intimidating at first, but it’s a safe and effective option for reducing the pain associated with this serious diabetes complication. By sending mild electrical pulses to the spinal cord, this therapy can help modulate pain signals before they reach the brain, providing significant relief and offering hope to those struggling with chronic pain. 

What is diabetic peripheral neuropathy?

According to the Centers for Disease Control (CDC), around half of all people with diabetes have some form of nerve damage. Over time, high blood sugar can damage blood vessels, causing poor circulation and inflammation, which deprives nerves of the oxygen they need to function properly. This can cause numbness, tingling, pain, or a “pins and needles” sensation in the feet, legs, hands or arms. This is called diabetic peripheral neuropathy (DPN), with the presence of pain more specifically known as painful diabetic peripheral neuropathy (PDPN). The feet are most commonly affected as well as the lower legs; the hands or arms can also be affected. In addition to sensations, diabetic peripheral neuropathy can also lead to serious complications such as foot ulcers.

The American Diabetes Association (ADA)’s newly published Standards of Care 2025 recommends screening for diabetic peripheral neuropathy at diagnosis of type 2 diabetes, or five years after diagnosis of type 1 diabetes, and annually from that point on. Treatment guidelines from the ADA focus on blood sugar management to slow the progression of diabetic neuropathy, as well as managing weight, cholesterol levels, and blood pressure. 

Certain medications, such as gabapentin (an anticonvulsant), antidepressants, or topical ointments may be used to help with any pain. Unfortunately, many patients don’t respond to these treatments, which is further complicated by the anxiety, depression, and sleep disorders associated with the condition. For individuals with painful diabetic peripheral neuropathy (PDPN), spinal cord stimulation offers a different way to relieve pain and improve quality of life. 

Spinal cord stimulation (SCS): An overview

Spinal cord stimulation therapy is an FDA-approved treatment for individuals with painful diabetic peripheral neuropathy of the lower extremities, offering an alternative to traditional pain management. The therapy works by delivering electrical impulses to the spinal cord through an implanted device, effectively blocking pain signals before they reach the brain. This helps alter the perception of chronic pain, providing significant relief for many patients.

The treatment typically begins with a trial period lasting up to 10 days to assess effectiveness, allowing patients to "test drive" the system before committing to full implantation. Multiple FDA-approved SCS systems, such as Nevro’s Senza and HFX iQ, as well as Medtronic’s Vanta, Intellis, and Inceptiv systems are available, each offering different features to cater to individual needs.

While spinal cord stimulation is generally safe and effective, it does carry some risks and complications. Despite these risks, the therapy has shown to significantly reduce pain and have promising secondary benefits, including improved sleep and better quality of life.

How spinal cord stimulation therapy can treat chronic pain

While the idea of an implanted device might sound frightening, there is growing evidence that spinal cord stimulation is a safe and effective treatment for people with painful diabetic peripheral neuropathy. 

Spinal cord stimulation therapy works by blocking pain signals from ever reaching the brain. A small device implanted under the skin called a neurostimulator sends electrical impulses to the spinal cord. The impulses travel from the neurostimulator to the spine through thin wires called leads, interrupting the pain signals from the legs before they reach the brain. By altering the perception of pain, these systems can provide relief for individuals with chronic pain. 

“The way I think of a spinal cord stimulator is sort of like a pacemaker for pain,” said Dr. Erika Petersen, professor of Neurosurgery, director of Functional and Restorative Neurosurgery at the University of Arkansas for Medical Sciences, adding: “Those electrical impulses can act like a signal jam to modify how nerve injury messages are transmitted.”

Usually, patients undergo an initial trial period, where they “test drive” the system before undergoing the actual implant procedure. During this trial, which can last up to 10 days, the leads are inserted near the spine using a special needle, and the impulses are controlled through an external stimulation device. Most individuals who elect to undergo the permanent spinal cord stimulator implant procedure after the trial can return to their normal activities after a couple of weeks.

Which SCS systems are approved for painful diabetic peripheral neuropathy?

In recent years, the FDA has approved multiple spinal cord stimulation systems, mostly for chronic back pain or leg pain. The first to be specifically approved for diabetic peripheral neuropathy was Nevro’s Senza, which delivered high-frequency (10 kilohertz) impulses to the spine (known as HF10 therapy). Notably, over 90% of participants experienced at least 50% pain reduction after 24 months. Nevro HFX iQ is the first AI-based system that was developed to account for the differences in pain levels among patients, helping users optimize and maintain long-term pain relief. 

Medtronic has also received FDA approval for its Vanta (recharge-free) and Intellis (rechargeable) systems, which allow patients to adjust the stimulation intensity using a remote control. In addition, their FDA-approved closed-loop Inceptiv SCS system addresses the variability in patient experience by sensing neural responses and automatically adjusting stimulation in real time. A long-term study of patients treated with one of Medtronic’s spinal cord stimulation devices found that 80% continued to use their devices after five years to manage their pain.

Abbott’s Proclaim XR SCS system and Boston Scientific’s WaveWriter Alpha SCS system have also recently received FDA approval for painful diabetic peripheral neuropathy.

More studies will need to be done to compare the effectiveness of different frequencies and to understand which criteria would make someone an ideal candidate for spinal cord stimulation. While the hands and arms can also be affected by diabetic peripheral neuropathy, it’s important to note that spinal cord stimulation is currently only FDA approved to treat DPN of the lower extremities.

The cost of the spinal cord stimulation procedure varies with the type of system and insurance you have, but generally it’s between $15,000-$20,000. For example, most major insurance providers, as well as Medicare (and sometimes Medicaid), cover Medtronic’s spinal cord stimulator. Check with your insurer to see if you are eligible for coverage. Depending on the patient’s insurance plan, out-of-pocket expenses for the procedure may vary widely up to several thousands of dollars for some plans. Follow-up treatments may also vary up to several hundred dollars per visit, depending on the healthcare provider and insurance plan.

Spinal cord stimulation risks and benefits

With any procedure, there are some side effects and complications that could arise. Patients undergoing spinal cord stimulation may experience pain, skin irritation, or fluid accumulation at the implant site, as well as numbness or tingling of their extremities (known as paresthesia). 

The most common complication of the implant procedure is lead migration, which is when the implanted electrodes move from their original location. When this happens, a follow-up surgery is usually required to put the electrodes back in the right spot. Other complications include infection, bleeding, and dural puncture, which is when a needle or electrode goes too deep and pierces the protective layer around your spinal cord. Although this is rare, dural puncture can lead to cerebrospinal fluid leaking out, causing headaches.

While there are risks associated with spinal cord stimulation, many studies have shown that it can offer significant, long-lasting pain relief for people with painful diabetic peripheral neuropathy, as well as provide secondary benefits such as improvements in sleep and quality of life. As with any medical procedure, it’s important for patients to have thorough discussions with their healthcare provider to fully understand the potential outcomes and make an informed decision about their treatment options.

The bottom line

While the term “spinal cord stimulation” may evoke some hesitation, the procedure is actually a well-established and effective therapy that can reduce pain and improve the quality of life of people living with painful diabetic peripheral neuropathy. If you have diabetes and are dealing with persistent nerve pain from diabetes, speak with your doctor to see if spinal cord stimulation could be a potential solution for you.

Learn more about potential treatments for diabetic neuropathy here:

• How to Avoid Nerve Damage in Your Hands and Feet With Diabetes
• Nerve Damage Beyond the Hands and Feet
• Alpha Lipoic Acid for Diabetic Neuropathy: Does It Work?
• Treating Diabetic Nerve Damage Without Surgery or Implants
• FDA Approves New Implantable Device to Treat Pain From Diabetic Nerve Damage

This content was made possible with support from Medtronic. All editorial content on diaTribe is based on the editorial team’s final discretion.

Photo credits: iStock (top); TGA.gov.au (bottom).