Spinal Cord Stimulation in Chronic Low Back Pain Syndrome: Mechanisms of Modulation, Technical Features and Clinical Application

Abstract

Chronic low-back pain (CLBP) is a common disease with several negative consequences on the quality of life, work and activity ability and increased costs to the health-care system. When pharmacological, psychological, physical and occupational therapies or surgery fail to reduce CLBP, patients may be a candidate for Spinal Cord Stimulation (SCS). SCS consists of the transcutaneous or surgical implantation of different types of electrodes in the epidural space; electrodes are then connected to an Implanted Pulse Generator (IPG) that generates stimulating currents. Through spinal and supraspinal mechanisms based on the “gate control theory for pain transmission”, SCS reduces symptoms of CLBP in the almost totality of well-selected patients and its effect lasts up to eight years in around 75% of patients. However, the evidence in favor of SCS still remains weak, mainly due to poor trial methodology and design. This narrative review is mainly addressed to those professionals that may encounter patients with CLBP failing conventional treatments. For this reason, we report the mechanisms of pain relief during SCS, the technical features and some clinical considerations about the application of SCS in patients with CLBP.

Neuromodulation techniques – From non-invasive brain stimulation to deep brain stimulation

“…In most cases, the electrodes are externalized, and the patient undergoes a trial period of stimulation to ensure adequate pain relief prior to internalization and connection to an implanted pulse generator. Traditional SCS is performed with tonic stimulation delivered at 40–60 hertz, set at an amplitude sufficient to elicit mild but non-bothersome paresthesias [ 165 , 166 ].…”

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

“…Another example of non-pharmacological treatment of CLBP is transcutaneous electrical nerve stimulation (TENS) [48]. Spinal cord stimulation [49][50][51] and nerve ablation [52,53] are also evaluated for their effectiveness in treating CLBP. In addition to diverse therapies and surgeries, self-management and patient education have been recognized as viable means to reduce pain intensity in CLBP patients [54][55][56][57].…”

Lifetime engineering of bioelectronic implants with mechanically reliable thin film encapsulations

“…One of the best-known classes of bioelectronic device is the implantable pulse generator (IPG), the applications of which range from cardiac pacemakers and cardioverter-defibrillators to deep-brain and spinal cord stimulation systems [193][194][195], all of which tend to utilize the classical hermetic packaging method of a rigid enclosure. IPGs may require complex circuitry to support pulse generation, timing functions, power management, communication, and processing, which are typically implemented on printed circuit boards (PCBs).…”