Advances in Interventional Therapies for Painful Diabetic Neuropathy

A Systematic Review

Li Xu, MD, PhD; Zhuo Sun, MD; Elizabeth Casserly, PharmD; Christian Nasr, MD; Jianguo Cheng, MD, PhD; Jijun Xu, MD, PhD


Anesth Analg. 2022;134(6):1215-1228. 

In This Article


In conclusion, emerging evidence indicates that interventional therapies can be effective in the management of refractory PDN. Based on systematic review of evidence, we recommend that SCS should be considered to reduce pain and improve quality of life (evidence level: 1B+) for patients with refractory PDN in the lower extremities. Acupuncture or botulinum toxin injection can be considered as an adjunctive therapy for PDN (2B+/1B+). Surgical decompression of specific peripheral nerves in the lower extremity can be considered in PDN patients with superimposed compression of the nerves (2B±/1B+). Lumbar sympathetic block can be used in select patients if the patient had a favorable response to the block (2C+). High-quality RCTs are warranted to further strengthen the evidence for these interventional treatments and to bridge many gaps identified in this review.