Current Perspectives on Neurostimulation for the Management of Chronic Low Back Pain: A Narrative Review

Provenzano, David; Heller, Jared A; Hanes, Michael

doi:10.2147/jpr.s249580

Cited by 15 publications

(9 citation statements)

References 80 publications

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“…1,2 According to current clinical guidelines, conventional medical management (CMM) for CLBP includes analgesic medications, physical therapy, nerve blocks, epidural steroid injections, radiofrequency ablation, and other therapies. [3][4][5][6] We use the terminology "nonsurgical refractory back pain" (NSRBP) to describe patients with chronic refractory back pain that does not respond to CMM and who have no history of spine surgery and are not acceptable candidates for surgery after evaluation by a spine surgeon. This term was first introduced in a publication by Patel el al.…”

mentioning

confidence: 99%

Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial

Kapural

Jameson

Johnson

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE Spinal cord stimulation (SCS) at 10 kHz (10-kHz SCS) is a safe and effective therapy for treatment of chronic low-back pain. However, it is unclear from existing evidence whether these findings can be generalized to patients with chronic back pain that is refractory to conventional medical management (CMM) and who have no history of spine surgery and are not acceptable candidates for spine surgery. The authors have termed this condition "nonsurgical refractory back pain" (NSRBP) and conducted a multicenter, randomized controlled trial to compare CMM with and without 10-kHz SCS in this population. METHODS Patients with NSRBP, as defined above and with a spine surgeon consultation required for confirmation, were randomized 1:1 to patients undergoing CMM with and without 10-kHz SCS. CMM included nonsurgical treatment for back pain, according to physicians’ best practices and clinical guidelines. Primary and secondary endpoints included the responder rate (≥ 50% pain relief), disability (Oswestry Disability Index [ODI]), global impression of change, quality of life (EQ-5D-5L), and change in daily opioid use and were analyzed 3 and 6 months after randomization. The protocol allowed for an optional crossover at 6 months for both arms, with observational follow-up over 12 months. RESULTS In total, 159 patients were randomized; 76 received CMM, and 69 (83.1%) of the 83 patients who were assigned to the 10-kHz SCS group received a permanent implant. At the 3-month follow-up, 80.9% of patients who received stimulation and 1.3% of those who received CMM were found to be study responders (primary outcome, ≥ 50% pain relief; p < 0.001). There was also a significant difference between the treatment groups in all secondary outcomes at 6 months (p < 0.001). In the 10-kHz SCS arm, outcomes were sustained, including a mean 10-cm visual analog scale score of 2.1 ± 2.3 and 2.1 ± 2.2 and mean ODI score of 24.1 ± 16.1 and 24.0 ± 17.0 at 6 and 12 months, respectively (p = 0.9). In the CMM arm, 74.7% (56/75) of patients met the criteria for crossover and received an implant. The crossover arm obtained a 78.2% responder rate 6 months postimplantation. Five serious adverse events occurred (procedure-related, of 125 total permanent implants), all of which resolved without sequelae. CONCLUSIONS The study results, which included follow-up over 12 months, provide important insights into the durability of 10-kHz SCS therapy with respect to chronic refractory back pain, physical function, quality of life, and opioid use, informing the current clinical practice for pain management in patients with NSRBP.

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confidence: 99%

Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial

Kapural

Jameson

Johnson

et al. 2022

Journal of Neurosurgery: Spine

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“…[23][24][25] Traditional SCS therapy provides steady delivery of electric current with a low frequency of 40 to 60 Hz, with pulse amplitudes ranging from 2 to 8 mA and typical pulse widths of 200 to 500 µs. 26 This type of current elicits paresthesias, and programming is targeted to maximize overlap of the paresthesias with painful regions. Newer paresthesia-free systems deliver HF current with lowamplitude current of up to 5 mA.…”

Section: Overview Of Scs Technologymentioning

confidence: 99%

“…A surgical technologist and a circulating nurse may also be present. 85 time for HF 10-kHz SCS is faster and less dependent on exposure to fluoroscopic radiation 73 ; and (3) evidence that HF 10-kHz SCS, but not traditional SCS, excites pain-inhibitory neurons in the dorsal horns of the spinal column and spares ascending pathways that carry sensations of paresthesias 26,74,75 (Table 3). On the contrary, traditional SCS, compared with HF 10-kHz SCS, has been used longer, so its properties are better known, and there is a more robust data set supporting the use of traditional SCS (Table 2) for diseases other than PDN.…”

Section: Deployment Of Scs Systemsmentioning

confidence: 99%

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Yeung

Huang

Nguyen

et al. 2022

J Diabetes Sci Technol

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Spinal cord stimulation (SCS) technology has been recently approved by the US Food and Drug Administration (FDA) for painful diabetic neuropathy (PDN). The treatment involves surgical implantation of electrodes and a power source that delivers electrical current to the spinal cord. This treatment decreases the perception of pain in many chronic pain conditions, such as PDN. The number of patients with PDN treated with SCS and the amount of data describing their outcomes is expected to increase given four factors: (1) the large number of patients with this diagnosis, (2) the poor results that have been obtained for pain relief with pharmacotherapy and noninvasive non-pharmacotherapy, (3) the results to date with investigational SCS technology, and (4) the recent FDA approval of systems that deliver this treatment. Whereas traditional SCS replaces pain with paresthesias, a new form of SCS, called high-frequency 10-kHz SCS, first used for pain in 2015, can relieve PDN pain without causing paresthesias, although not all patients experience pain relief by SCS. This article describes (1) an overview of SCS technology, (2) the use of SCS for diseases other than diabetes, (3) the use of SCS for PDN, (4) a comparison of high-frequency 10-kHz and traditional SCS for PDN, (5) other SCS technology for PDN, (6) deployment of SCS systems, (7) barriers to the use of SCS for PDN, (8) risks of SCS technology, (9) current recommendations for using SCS for PDN, and (10) future developments in SCS.

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“…Chronic pain conditions such as complex regional pain syndrome (CRPS) and persistent spinal pain syndrome (ie, failed back surgery syndrome, FBSS) are intractable to many treatment options and often involve the deployment of spinal cord stimulation (SCS) in order to achieve effective pain control 1 2. Over the last decade, there has been significant advancement in SCS which continues to improve the response rates and effectiveness of the treatment 3–5.…”

Section: Introductionmentioning

confidence: 99%

Daring discourse: economics of neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome

Provenzano

Heller

2023

Reg Anesth Pain Med

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The treatment options for patients with chronic pain conditions are impacted by recent research, patient needs, and insurance coverage. Although various factors affect the cost of healthcare, the economic burden on the patient and the healthcare system must be considered when choosing the appropriate treatments for each patient. This Daring Discourse aims to review and further clarify existing economic evaluations and thus examine cost-effectiveness with regards to neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome. Specific consideration is given to spinal cord stimulation, as it is a widely studied and implemented neuromodulation modality for the treatment of these debilitating conditions.

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Current Perspectives on Neurostimulation for the Management of Chronic Low Back Pain: A Narrative Review

Cited by 15 publications

References 80 publications

Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial

Treatment of nonsurgical refractory back pain with high-frequency spinal cord stimulation at 10 kHz: 12-month results of a pragmatic, multicenter, randomized controlled trial

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Daring discourse: economics of neuromodulation for the treatment of persistent spinal pain syndrome and complex regional pain syndrome

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