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New relief available for patients with painful diabetic condition

what is PDN?

Did you know that 1 in 10 Americans have diabetes?  A complication of diabetes is painful diabetic neuropathy (PDN), which develops in 25% of diabetics within the first 5 years, and in 50% within 25 years of having the disease.  

Lifestyle adjustments such as blood-sugar management and careful care of the feet often are used with patients, but there have been few approved approaches that specifically target the neuropathic pain. Unfortunately, less than 50% of patients get relief with medications. Until now, PDN has had limited treatment options.

PDN develops when high blood glucose levels damage the nerves that connect your spinal cord and brain with your arms, legs, hands, and feet, making way for peripheral neuropathy. PDN can lead to the development of symptoms of numbness, burning, tingling, “pins and needles”, sharp, shooting and throbbing pain, and coldness in the lower legs and feet. This is sometimes described as a “stocking distribution” of symptoms.

In addition to uncontrolled blood sugar, risk factors include obesity, high blood pressure, and smoking. Addressing painful DPN is also important because it can raise your risk for foot ulcers and amputation. Because of numbness, you might not notice cuts or wounds in affected areas, which makes infections and gangrene more likely.

PDN Treatment

Medication can help reduce pain from peripheral diabetic neuropathy by 30-50%, but it’s usually not sufficient on its own. Moreover, all of the medications used for PDN have notable side-effects, and some actually can further raise your blood surgars.

You can also lower your risk for further nerve damage related to DPN through diabetes-friendly lifestyle measures, such as:

  • Eating a balanced, nutritious diet
  • Exercising regularly
  • Following your prescribed treatment plan
  • Regularly monitoring your blood sugar levels
  • Sth2ying in close contact with your health care providers
  • Supplements, such as B-vitamins, acetyl-L-carnitine, among others.

Recently, in 2021, a randomized, controlled study (RCT) was published in JAMA Neurology of 216 patients suffering from PDN. The study demonstrated that 86% of patients receiving HFX therapy achieved 50% or greater pain relief compared to only 5% of patient reporting relief with medications alone.

The HXF patients experienced an average of 75% reduction of their leg pain, and 92% were highly satisfied with the therapy. The HFX patients also reported improvement in sleep as well as quality of life as a result of HFX therapy.

Amazingly, 68% of patients showed actual improvement in their sensation and strength with treatment, an improvement that medications do not provide. Hopefully this will lead to less falls, less amputations, and improved mobility and quality of life!

The graphic below shows a visual representation of improvements in numbness, burning, tingling and cold reported by patients receiving HFX therapy. Lower amounts of red represents a lower degree of symptoms.

what is HFX Therapy?

HFX stands for “High Frequency, 10 kHz”. This refers to a non-drug, high-frequency spinal cord stimulating device that has been used in over 70,000 patients suffering from chronic back and leg pain due to spinal pathology. The high-frequency stimulation allows patients to achieve pain relief without the tingling that is typically felt with old-school traditional spinal cord stimulation.

Similar to a cardiac pacemaker, in spinal cord stimulation, a device about the size of an Oreo cookie is implanted in the lower back and delivers mild and invisible electrical pulses to the spinal cord via two small wires that are implanted in the spine, interrupting pain signals before they reach the brain.

It is used most often to help patients after conservative therapies have failed and when the patient would not benefit from additional surgery. Spinal cord stimulation has been a proven therapy for decades, but recent advances produce faster and more efficient technology – up to 10,000 beats per second.

In addition, using HFX therapy has no side effects like drowsiness and brain fog, which is a common problem with PDN medication treatments.

For more information on the HFX system, visit

what is the HFX process like?

Once the patient has been identified as a potential candidate for HFX therapy, they will be evaluated by Dr. Musser. Appropriate testing will be completed and the patient will be scheduled for a trial of HFX. This involves placement of 2 small electrical wires (the size of a piece of spaghetti pasta) through a needle into the epidural space. These are placed very carefully and precisely using x-ray guidance in a similar fashion to an epidural steroid injection. This is an outpatient procedure that is relatively quick and painless.  Patients will typically undergo a one-week trial so that they can determine whether or not HFX therapy helps them. If there is a 50% improvement in pain or better, the patient will be offered a permanent implantation of and HFX device. Again, most patients (86%) have on average a 75% reduction in their pain. 

The permanent implantation involves a minimally invasive outpatient surgery to implant a small battery the size of an Oreo cookie under the skin above your beltline which can be controlled with a remote control. This surgery is also relatively quick, and you’ll be able to go home the same day.

HFX therapy is an FDA-approved breakthrough therapy that may provide meaningful and durable pain relief in patients suffering from PDN. It is covered by Medicare and most insurance policies, and should be considered if PDN is present and is negatively impacting a person’s quality of life.

Contact Regenerative Orthopaedics and Spine Institute

If you have been experiencing painful diabetic neuropathy, you may benefit from implanting the HFX device. Contact ROSI to learn more about your options for HFX spinal cord stimulation, combating chronic pain, and improving the quality of your life. Our team at ROSI are local experts in providing HFX therapy for diabetic neuropathy pain, as well as for other types of chronic pain. 

To learn more about painful peripheral diabetic neuropathy or to get started with the care you need, call our office most convenient to you or request an appointment online today.



John Tobias Musser, MDM

Tobias Musser, MD, FAAPMR, is board-certified in physical medicine & rehabilitation (PM&R) with subspecialty fellowship training in interventional pain management. He serves Atlanta-area patients at Regenerative Orthopaedics and Spine Institute, which has two locations in Griffin and Stockbridge, Georgia.
Dr. Musser has been practicing interventional pain medicine for the past 10 years, specializing in image-guided musculoskeletal and spine injections to aid in diagnosing and treating common and complex painful musculoskeletal conditions. As a leading interventional orthopedic and pain management physician in the Greater Atlanta area, Dr. Musser is also specialty-trained in orthopedic regenerative medicine treatments and is one of only a few providers in Georgia with added qualifications and training through the Interventional Orthopedics Foundation.
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