A review of spinal cord stimulation systems for chronic pain

Abstract

Spinal cord stimulation (SCS) applications and technologies are fast advancing. New SCS technologies are being used increasingly in the clinical environment, but often there is a lag period between the clinical application and the publishing of high-quality evidence on safety and efficacy. Recent developments will undoubtedly expand the applicability of SCS, allowing more effective and individualized treatment for patients, and may have the potential to salvage patients who have previously failed neuromodulation. Already, high-level evidence exists for the safety, efficacy, and cost-effectiveness (Level I–II) of traditional SCS therapies in the treatment of chronic refractory low back with predominant limb pain (regardless of surgical history). More than half of all patients with chronic painful conditions experience sustained and significant levels of pain reduction following SCS treatment. Although only limited evidence exists for burst stimulation, there is now Level I evidence for both dorsal root ganglion SCS and high-frequency SCS that demonstrates compelling results compared with traditional therapies. The body of evidence built on traditional SCS research may be redundant, with newer iterations of SCS therapies such as dorsal root ganglion SCS, high-frequency SCS, and burst SCS. A number of variables have been identified that can affect SCS efficacy: implanter experience, appropriate patient selection, etiologies of patient pain, existence of comorbidities, including psychiatric illness, smoking status, and delay to SCS implant following pain onset. Overall, scientific literature demonstrates SCS to be a safe, effective, and drug-free treatment option for many chronic pain etiologies.

Benefits in pain perception, ability function and health-related quality of life in patients with failed back surgery syndrome undergoing spinal cord stimulation in a clinical practice setting

“…To note, both Cho et al and Warszak et al, [ 39 , 40 ] exclude from their review, for not clear reasons, the results of some studies, including the cost-effective and the cost-utility analysis we published in 2015 [ 13 ], which could have influenced their conclusion [ 41 ]. In other recent literature reviews [ 42 , 43 ], the authors conclude that evidence exists for SCS as a safe, effective and efficient treatment for several chronic pain conditions. Although most of the higher-quality evidence is relatively short-term, clinical experience with the durability of treatment benefit of SCS in these patients is promising.…”

A Retrospective Analysis of 25 Cases With Peripheral Nerve Field Stimulation for Chronic Low Back Pain and the Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection

“…Kumar et al showed in patients with low back pain, that an early performed neuromodulative treatment is associated with a better improvement in pain relief and generic health status (53). Early neuromodulative treatment further could lead further to a reduction of pharmaceutical treatments and its dependency with all side-effects resulting in an improvement of quality of life (54). The procedure is safe and reversible (18).…”

Identifying the Role of Block Length in Neural Heat Block to Reduce Temperatures During Infrared Neural Inhibition

“…Development of nonpharmacological therapies is critical, resulting in government initiatives to better understand and treat chronic pain [9][10][11]. Electrical interventions such as spinal cord stimulation [12][13][14] and high frequency alternating current [15][16][17], whether used in acute applications or implanted for chronic therapy, can provide relief, but are limited in their spatial specificity (precise spatial targeting of neurons) due to the tendency of electric current to spread in tissue and tolerance effects where more current is needed for therapy as time progresses, which results in even more current spread and reduced specificity. It has been shown that combining electrical therapy with optical modulation may help overcome some of these limitations [18].…”

“…This method can be noncontact with tissue, however in many cases, probes delivering irradiation are placed in contact with the nerve, especially when delivering IR light in a fluid environment since the surrounding media will absorb the light before it reaches the nerve. The proximity to the neural tissue needed for INI highlights that clinical application would require surgical exposure of neural tissues for therapy, however, this is often performed when applying spinal cord stimulation [14]. The greatest barrier to clinical implementation is the temperatures associated with INI.…”