Both type 1 and type 2 diabetes can lead to diabetic peripheral neuropathy (DPN), the most common form of diabetic neuropathy. DPN is caused by chronic hyperglycemia, resulting in a length-dependent, symmetric sensory polyneuropathy that typically presents with burning pain and sensory loss in a stocking-glove distribution. First-line pharmacologic management includes gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants. However, many patients experience inadequate pain control or intolerable side effects. For patients with refractory painful DPN, spinal cord stimulation (SCS) is an evidence-based, FDA-approved intervention. High-frequency (10 kHz) SCS provides paresthesia-free stimulation and has been shown to improve pain, sleep, quality of life, and neurological function.

A 66-year-old male with end-stage renal failure and type 2 diabetes presented with constant bilateral foot pain, described as burning and pins-and-needles, that limited walking to 15 minutes. In November 2024, he received permanent implantation of a Nevro HFX AdaptivAI high-frequency SCS system. The platform incorporates an algorithm that uses daily patient input to recommend and adjust programming settings. After implantation, he consistently reported 60–70% pain relief and improved function, and the recommended settings are now maintained on a low-energy pulse dose program. He also reduced gabapentin from 900 mg BID to 300 mg BID and stopped taking bupropion HCl XL 150 mg.

This case highlights the role of artificial intelligence–enhanced neuromodulation in managing refractory painful DPN. High-frequency SCS with adaptive, patient-directed programming is an evolving strategy that improves pain, function, and quality of life compared with pharmacologic therapy alone.

Emily Ma is a third-year medical student at Western University of Health Sciences COMP-Northwest. She earned a BS in Human Physiology, cum laude, with a minor in Chemistry. Her undergraduate research focused on amino acid–modulated motility in a zebrafish bacterial isolate. At WesternU, she is involved in osteopathic manipulative medicine research, focusing on somatic and visceral techniques for managing chronic abdominal pain. In her free time, she enjoys travelling, playing tennis, practicing calisthenics, and designing dresses