Automated ‘pain drawing’ analysis by computer-controlled, patient-interactive neurological stimulation system

Abstract

We have developed a new method for the collection and analysis of pain drawings, as part of a computer-controlled, patient-interactive system for use with implanted neurological stimulators. The system has been tested in 44 patients with permanently implanted spinal cord stimulators for the relief of chronic, intractable pain. Patients interact directly with the system, using a graphics tablet, to enter pain drawings and corresponding outlines of their perceptions of stimulation paresthesias, for different stimulating pulse parameters and electrode geometries. Image analysis software has been developed to examine these data quantitatively. This precludes the inter-rater inconsistencies reported for manual pain drawing scoring techniques. A highly significant correlation has been observed between patients' analog ratings of the overlap of pain by paresthesias and the results of our automated analysis of graphic data. This in turn has been found to correlate with clinical observations of pain relief. The contemporary implantable stimulation devices supported by our system permit non-invasive selection of stimulating anodes and cathodes from a linear array of 4 electrodes. The 50 possible electrode combinations have certain geometric features, which we have entered into a multivariate statistical analysis, to determine their relationship with the overlap of pain by paresthesias. One particular configuration (cathode(s) flanked by anode(s) above and below) is significantly better, by this measure, than all the alternatives. This is consistent with prior clinical observations that this configuration is favored by patients whose systems have been adjusted by conventional, manual methods. Pain drawing' entry and analysis by a computerized, patient-interactive system has been useful in this specialized setting and may have broader applications.

Spinal Cord Stimulation for Axial Low Back Pain

“…14,20,21 We positioned the 1 ϫ 4 in the radiographic midline under fluoroscopic guidance and delivered test stimulation with a single anode immediately caudad to a single cathode. 14,20,21 We positioned the 1 ϫ 4 in the radiographic midline under fluoroscopic guidance and delivered test stimulation with a single anode immediately caudad to a single cathode.…”

Spinal cord stimulation with percutaneous and plate electrodes: side effects and quantitative comparisons

“…The patient-interactive system used for this study has been described previously. [6,7] All tests were performed with the patient sitting upright or slightly recumbent. The combinations affording the best clinical performance (per patient rating of overlap at usage threshold) were tested in greater detail; the thresholds of first perception, bilateral perception, low-back coverage, and discomfort were all recorded, along with graphic data that was entered directly by each patient.…”

Spinal cord stimulation in chronic pain management

“…Multiple electrode arrays with multiple contacts allow one to reach this goal more easily; because they can be reprogrammed from outside the body, it is also possible to overcome the problem of slight changes of paresthesias, reducing the need for further surgery. Conversely, by increasing the complexity of the stimulation devices, particularly the number of electrodes and contacts, the number of possible combinations (and, consequentially, the need for computer programming and dedicated professionals) is increased exponentially [10][11][12][13].…”