Subcutaneous Target Stimulation (STS) in Chronic Noncancer Pain: A Nationwide Retrospective Study

Abstract

Stimulation of primary afferent neurons offers a new approach for the control of localized chronic pain. We describe the results with a new neurostimulation technique, subcutaneous target stimulation (STS), for the treatment of chronic focal noncancer pain. STS applies permanent electrical stimulation directly at the painful area via a percutaneous-placed subcutaneous lead. We reported the clinical outcomes of 111 patients with focal chronic, noncancer pain treated with STS in this first nationwide, multicenter retrospective analysis. The indications for STS were low back pain (n = 29) and failed back surgery syndrome (back pain with leg pain) (n = 37), cervical neck pain (n = 15), and postherpetic neuralgia (n = 12). Pain intensity was measured on a numerical rating scale (NRS) before and after implantation. Data on analgesic medication, stimulation systems, position, and type of leads and complications were obtained from the patients' records. After implantation, the mean pain intensity improved by more than 50% (mean NRS reduction from 8.2 to 4.0) in the entire patient group (P = 0.0009). This was accompanied by a sustained reduction in demand for analgesics. In all the patients, the STS leads were positioned directly at the site of maximum pain. Lead dislocation occurred in 14 patients (13%), infections in 7 (6%), and in 6 cases (5%), lead fractures were observed. The retrospective data analysis revealed that STS effectively provided pain relief in patients suffering from refractory focal chronic noncancer pain and that STS is an alternative treatment option. Prospective controlled studies are required to confirm these retrospective findings. This article presents a new minimally invasive technique for therapy-resistant focal pain.

Spinal cord stimulation for neuropathic pain: current perspectives

“…Pain scores in total decreased from 8.2 without stimulation to 4.0 with stimulation. The mean medication use was significantly reduced 69. A recent prospective multicenter study on 118 patients of PFNS on chronic low back pain showed similar results 70…”

“…Interestingly, pain relief by TENS does not seem to be a predictor for the success of PFNS,71 and pain relief elicited by PNFS seems to be stronger than in TENS 69. A so-called “hybrid simulation”, combining SCS and PFNS, has also been proposed for various pain syndromes 61,62,65,67,72–74…”

Assessing the effectiveness and cost effectiveness of subcutaneous nerve stimulation in patients with predominant back pain due to failed back surgery syndrome (SubQStim study): study protocol for a multicenter randomized controlled trial

“…Following SQS, the reduction in mean VAS ranged from 4.2 to 1.7. Five studies also reported improvements in the level of analgesia medication, [14,17-20] and three reported improvements in functional capacity compared to before SQS [13,16,18]. …”

“…Across the 3 studies reporting data, a total of 41 out of 224 (18%) patients experienced 1 or more device-related complication [14,18,19]. Risks of specific complications were as follows: lead migration, 19/245 (8%, 5 studies [14,16-19]); other lead complications (for example, fracture), 10/211 (5%, 2 studies [14,19]); hardware erosion, 0/13 (0%, 1 study [10]); infection, 9/258 (3.5%, 6 studies [12,14,17-20]); and device migration 1/113 (<1%, 2 studies [12,19]).…”

Subcutaneous Target Stimulation or Peripheral Subcutaneous Field Stimulation: That Is the Question

“…However, in an Austrian national study's (5) recent publication, the largest study to date, which included 111 patients, the term of “subcutaneous target stimulation” (STS) is used (11). Also, in another report by Theodosiadis et al.…”