Spinal Cord Stimulation and Small Fiber Peripheral Neuropathy

Inclusion Criteria: * Over 18 years old * Diagnosis of diabetic peripheral neuropathy refractory to treatment with gabapentin or pregabalin and at least 1 other class of analgesic * Diagnosis of medically refractory pain secondary to diabetic neuropathy * Presence of pain for 12 months * Lower limb pain intensity score ≥4 on a visual analog scale * DN4 ≥4 * Pass pre-operative neuropsychological assessment (surgical group only) * Capable of providing informed consent Exclusion Criteria: * Severe medical comorbidities that, in the opinion of the surgeon, exclude the patient from surgical intervention * Spinal disease with severe spinal stenosis or spinal cord compression in the region of the proposed spinal cord stimulator lead placement * Coagulopathy that cannot be corrected * Unable to discontinue blood thinning medications * Hemoglobin A1c level greater than 10 * Presence of systemic infection * Pregnancy