| In the United States the prevalence of overweight | | | | Percutaneous minimum invasive pain management |
| and obesity dramatically increasing the incidence of | | | | technique is part of continuous strategy of |
| diabetes. According to W.H.O. in the year of 2010 it | | | | permanent pain treatment that is widely use in nova |
| would be 220 million people with diabetes worldwide. | | | | days implanting the leads into epidural space and |
| This statistics demonstrate the necessity of physician | | | | connecting them to subcutaneously positioned of |
| education not only in the treatment of diabetes but | | | | spinal cord stimulator. Spinal cord stimulation applies |
| also in the managing of diabetes complications. Nearly | | | | electrical current in the form of short bursts or pulses |
| a quarter of diabetes patient is already suffering | | | | to a specific area of the spinal cord. The pain control |
| from diabetic peripheral neuropathy and up to 50% | | | | is very satisfactory in peripheral diabetic neuropathy |
| of all diabetics develop peripheral neuropathy after 25 | | | | patient population. Spinal Cord Stimulation has been |
| years of having this disease. Patients with diabetic | | | | used for many patients with failed back surgery |
| peripheral neuropathy often presenting with pain that | | | | syndrome after laminectomy as an alternative to |
| characterize as burning, aching, tingling, cold, allodynia | | | | re-operation. It has also been used to treat Complex |
| and/or numbness. There are numerous therapeutic | | | | Regional Pain Syndrome (former Reflex Sympathetic |
| agents are available but there is no single therapeutic | | | | Dystrophy), post herpetic neuralgia, spinal cord injury |
| agent available that is without adverse side effect | | | | and many others. Traditionally, Neurostimulation was |
| and it is completely effective for the general diabetic | | | | reserved as a late modality in the pain treatment |
| population. Tricyclic antidepressants such as | | | | continuum. In nova days, Spinal Cord Stimulation |
| amitriptyline, imipramine, desipramine, and nortriptyline | | | | treatment implementing in pain treatment in earlier |
| are useful in treatment of diabetic neuropathy. | | | | stage can enhance multidisciplinary care by facilitating |
| Pregabaline, gabapentin, tramadol and many others | | | | participation in activities, such as physical therapy, |
| also are available for the treatment of diabetic | | | | which is essential for rehabilitation. |
| peripheral neuropathy. When the right agent is | | | | Dr. A. Krakovsky, M.D., PhD., Dr., Sc. is an |
| determined, it does not necessarily relieve the pain in | | | | interventional pain management physician, a professor |
| 100%. The physician must manage the patient on | | | | of medicine and surgery. Dr. Krakovsky leads |
| multiple levels using all available modalities in | | | | International Pain Institute in La Jolla, CA providing |
| multi-functional strategy to alleviate initial pain and | | | | procedures to elevate pain. |
| manage progression to other complications. | | | | |