Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

One out of 4 specialist commentators was familiar with or had used this technology before.

Level of innovation

All commentators agreed that this device was innovative with 2 stating that it was a minor innovation and 1 classing it as a novel device.

Potential patient impact

All commentators agreed that the main patient impact would be a reduction in pain or improvement in quality of life. Two commentators noted that these effects may only be short-term. Three commentators stated that this treatment may be best for patients whose condition has failed to respond to standard pharmacological treatment.

One commentator stated that this treatment could lead to a reduction in medication use, and 2 commentators stated that there was a possibility that it could lead to improved clinical outcomes. One commentator noted that this treatment might lead to increased hospital visits for the patient. Another commentator noted that this patient cohort has many comorbidities, which may make it difficult for them to attend all their appointments and complete a therapy cycle. One commentator felt that only a small proportion of people with diabetes might be eligible for this treatment; another stated that this could be up to 50% of those with painful diabetic neuropathy, but that this would depend on how the target population was defined. One noted that many patients with painful diabetic neuropathy can be managed successfully with medication, but this has an element of trial and error with several different medications.

Potential system impact

All commentators agreed that this device would most likely be an addition to standard care, and would therefore need additional resources including staff time, appointment rooms and equipment. One commentator stated that the improvement in clinical outcomes could lead to a reduced burden on other areas of the NHS and care services. One noted that it would most likely cause an increase in outpatient appointments. However, another commentator stated that this device may cost less than some current medications without the burden of associated side effects. Three commentators agreed that specialist training is needed in order to introduce this device to the care pathway, but one stated that staff had found the device easy to use after the training. A fourth commentator noted that additional personnel would be needed to manage each patient.