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