Managing Chronic Pain With Spinal Cord Stimulation

Abstract

Since its introduction as a procedure of last resort in a terminally ill patient with intractable cancer‐related pain, spinal cord stimulation has been used to effectively treat chronic pain of varied origins. Spinal cord stimulation is commonly used for control of pain secondary to failed back surgery syndrome and complex regional pain syndrome, as well as pain from angina pectoris, peripheral vascular disease, and other causes. By stimulating one or more electrodes implanted in the posterior epidural space, the patient feels paresthesias in their areas of pain, which reduces the level of pain. Pain is reduced without the side effects associated with analgesic medications. Patients have improved quality of life and improved function, with many returning to work. Spinal cord stimulation has been shown to be cost effective as compared with conservative management alone. There is strong evidence for efficacy and cost effectiveness of spinal cord stimulation in the treatment of pain associated with intractable angina, failed back surgery syndrome, and complex regional pain syndrome. In this article, we review the history and pathophysiology of spinal cord stimulation, and the evidence (or lack thereof) for efficacy in common clinical practice. Mt Sinai J Med 79:123–132, 2012. © 2012 Mount Sinai School of Medicine

A Multicenter, Prospective Trial to Assess the Safety and Performance of the Spinal Modulation Dorsal Root Ganglion Neurostimulator System in the Treatment of Chronic Pain

“…Similar to previously reported values , one subject reported uncomfortable stimulation, a usually transitory issue associated with developing an effective program for the individual. However, it should be noted that other neuromodulation systems using dorsal column stimulation elicited uncomfortable paresthesias, which could presume some dorsal root/DRG involvement .…”

Nanostructured platinum grass enables superior impedance reduction for neural microelectrodes

“…Furthermore such technology provides a versatile tool box [1] for applications in diagnostics, therapy and rehabilitation. Current research addresses pain therapy by means of spinal cord stimulation [2], deep brain stimulation to treat symptoms of Parkinson's disease and severe psychiatric disorders [3,4], epilepsy diagnostics, artificial limb control [5], lost body function replacement [6] and modulation [7] or the development of brain computer interfaces [8,9], for example. All of these applications are enabled by electrodes that mediate the connection between the biological and the technical side of the neural interface.…”

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“…Patients who respond well during the trial period and achieve pain relief, improved quality of life, or increased activity become candidates for permanent lead and generator placement. 4,11 Complications from SCS include lead migration, lead connection failure, lead break, local pain, wound seroma, hematoma and infection. Hardware-related complications are the most common and can occur in 11-36% of patients, with infection being the next most common, occurring in 3-6.3% of patients.…”