Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

Wong, Stanley Sc; Chan, CW; Cheung, CW

doi:10.12809/hkmj176288

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…1B). This electrode has widespread use for modulating chronic pain 59,60 and therefore the safety and efficacy of the device has been previously demonstrated. In recent years, the device has been repurposed and shown efficacy for step/stand training 61 , cardiovascular control 62 , and bladder function 8 in SCI individuals.…”

Section: Spinal Cord Epidural Stimulation (Sces) Electrode Arrays Momentioning

confidence: 99%

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Hoey

Medina-Aguiñaga

Khalifa

et al. 2021

Sci Rep

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Spinal cord epidural stimulation (scES) mapping at L5-S1 was performed to identify parameters for bladder and bowel inhibition and/or contraction. Using spinally intact and chronic transected rats of both sexes in acute urethane-anesthetized terminal preparations, scES was systematically applied using a modified Specify 5–6–5 (Medtronic) electrode during bladder filling/emptying cycles while recording bladder and colorectal pressures and external urethral and anal sphincter electromyography activity. The results indicate frequency-dependent effects on void volume, micturition, bowel peristalsis, and sphincter activity just above visualized movement threshold intensities that differed depending upon neurological intactness, with some sex-dependent differences. Thereafter, a custom-designed miniature 15-electrode array designed for greater selectivity was tested and exhibited the same frequency-dependent urinary effects over a much smaller surface area without any concurrent movements. Thus, select activation of autonomic nervous system circuitries with scES is a promising neuromodulation approach for expedient translation to individuals with SCI and potentially other neurologic disorders.

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Section: Spinal Cord Epidural Stimulation (Sces) Electrode Arrays Momentioning

confidence: 99%

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Hoey

Medina-Aguiñaga

Khalifa

et al. 2021

Sci Rep

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show abstract

“…At present, the ESCS electrodes used in clinical trials are mainly designed to treat analgesia (Harkema et al, 2011;Wong et al, 2017;Gill et al, 2018). For the recovery of movement, a higher spatial resolution is needed than for treating analgesia.…”

Section: Introductionmentioning

confidence: 99%

A flexible electrode array for determining regions of motor function activated by epidural spinal cord stimulation in rats with spinal cord injury

Mao

Zhang

et al. 2022

Neural Regen Res

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“…Traditionally, leads are advanced to the thoracic (T8/T9) level, where they are programmed to achieve maximum paresthesia topographic coverage and leg pain alleviation. The power source, an implantable pulse generator (IPG) or radiofrequency unit, is then connected to the leads (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…SCS is traditionally reserved for lumbosacral radiculopathy or chronic back pain that is refractory to other non-or less invasive techniques. Evidence supports its use mostly in failed back surgery syndrome (FBSS), where patients see up to 50% pain intensity reduction, and complex regional pain syndrome (CRPS), where up to 38% alleviation was previously demonstrated (3,4). SCS devices are currently approved by the Food and Drug Administration (FDA) for use as an aid in the management of chronic intractable pain of the trunk or limbs associated with FBSS, CRPS, intractable low back pain, and leg pain (7, 8).…”

Section: Introductionmentioning

confidence: 99%

Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

et al. 2021

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Background: Chronic back and neck pain affects 20% of Americans. Spinal cord stimulation (SCS) is an effective therapy for otherwise refractory chronic pain. Traditional SCS relies on low-frequency stimulus in the 40 - 60 Hz range causing robust paresthesia in regions overlapping with painful dermatomes. Objectives: This study aims to determine the effect of superimposing sub-perception stimulation in patients who previously had good long-term relief with paresthesia. Methods: This is a prospective observational trial examining patients who had previously been implanted with paresthesia based SCS for failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). These patients presented for implantable pulse generator (IPG) replacement based on battery depletion with an IPG capable of combined sub-perception and paresthesia based SCS therapy. Patients were assessed immediately following the exchange and four weeks later using a telephone survey. Their pain was assessed on each follow up using a Numerical Rating scale (NRS); the primary outcome was the change in NRS after four weeks from the exchange day. Secondary outcomes included paresthesia changes, which included the subjective quality of sensation generated, the overall subjective coverage of the painful region, subjective variation of coverage with positional changes, and global perception of the percentage improvement in pain. Results: Based on our clinic registry, 30 patients were eligible for IPG exchange, 16 were consented for follow up and underwent an exchange, and 15 were available for follow up four weeks following. The average NRS decreased from 7.47 with traditional SCS to 4.5 with combination therapy. 80% of patients reported an improvement in the quality of paresthesia over traditional SCS therapy, and in most patients, this translated to significantly improved pain control. Conclusions: Our findings suggest improved pain relief in patients who had previously had good results with paresthesia based therapy and subsequently underwent IPG exchange to a device capable of delivering combined sub-perception stimulation. The mechanism of action is unclear though there may be an additive and/or synergistic effect of the two waveforms delivered. Larger studies with long-term follow-up are needed to elucidate the durability of pain relief and the precise mechanism by which combined subperception and paresthesia based SCS may improve overall patient outcomes.

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Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

Cited by 12 publications

References 29 publications

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

Bladder and bowel responses to lumbosacral epidural stimulation in uninjured and transected anesthetized rats

A flexible electrode array for determining regions of motor function activated by epidural spinal cord stimulation in rats with spinal cord injury

Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional Paresthesia Based Waveforms: A Pilot Study

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