Spinal Cord Stimulation for Diabetic Polyneuropathy

There is a medication arm and a stimulation arm. Patients will randomized to one or the
other. If patients are randomized to the medication arm, after 6 months they have the option
of going into the stimulation arm. There is a 3 week trial which includes a crossover period
from "no stimulation" to subthreshold stimulation. The 3rd week patients will receive
"optimal" stimulation. If they qualify, they will be implanted with the permanent device.

Inclusion Criteria:

1. The subject is 18 years of age or older

2. The subject has signed and received a copy of an informed consent form after the
nature of the study has been fully explained.

3. The subject has a clinical diagnosis of diabetes mellitus

4. The subject has an A1C less than or equal to 10% within the last 3 months.

5. The subject has been on a stable diabetic therapy for at least 3 months without
hospitalizations for control of diabetes.

6. The subject has a documented clinical diagnosis of painful diabetic distal symmetric
sensory/motor polyneuropathy using the LANSS (Leeds assessment of neuropathic symptoms
and signs) pain scale score of 12 or greater and the TNS (total neuropathy score)
score of 20 or greater.

7. The subject has bilateral, moderate to severe pain from diabetic polyneuropathy for
the previous 3 months.

8. The subject has a VAS of > 4 at Baseline, on a stable analgesic regimen consisting of
any one or combination of the following agents: anticonvulsants, antidepressants, and
opioids for 1 month.

9. The subject has been shown to be refractory to conservative therapy by failing a
minimum of 3 conservative treatments at least one of which is a medication
specifically for diabetic polyneuropathy of adequate dose and duration

10. Female subject has a negative pregnancy test.

Exclusion Criteria:

1. Subject is unwilling or unable, in the opinion of the investigator, to comply with
study instructions.

2. Subject has other severe pain that could confound the assessment of pain due to
diabetic polyneuropathy.

3. Subject has a neuropathy that the investigator considers is not due to diabetes (e.g.,
significant vasculitis, collagen vascular disorder, medications known to cause
neuropathies, history of familial neuropathy, drug or alcohol abuse, hepatitis, HIV,
infection or pernicious anemia)

4. Subject has had any amputation.

5. Subject has a diagnosis within the past 1 year of major psychiatric disturbance.
Exclusionary psychiatric diagnoses include the following Axis I disorders (DSM-IVR
criteria): major depression, bipolar disorder, schizophrenia or other psychotic
disorder or somatoform disorders. The Axis II disorder of borderline personality is
also excluded.

6. Subject has co-existent, major systemic disease(s) that would interfere with
interpretation of study results (e.g. malignancy, poorly controlled diabetes, ischemic
cardiac disease, profound autonomic dysfunction or any other disease in the opinion of
the investigator.)

7. Subject who has an abnormal PT, PTT, bleeding time or platelet count that might
interfere with therapy.

8. Subject is currently participating in or has, within the past 30 days, participated in
a study of another investigational drug or device.

9. Subject has a history of substance abuse within the past 2 years.

10. Subject has a demand-type pacemaker or implanted cardiac defibrillator.

11. Subject who require diathermy or MRIs.

12. Subject with any metallic implants that might interfere with this therapy in the
opinion of the investigator;

13. Subject who has an implanted medication pump or implanted neurostimulation device.

14. Subject who currently has an active infection.

15. Subject who currently has foot ulcers.