The Effects of Spinal Cord Stimulation in Neuropathic Pain Are Sustained

Kumar, Krishna; Taylor, Rod S; Jacques, Line; Eldabe, Sam; Meglio, Mario; Molet, J.; Thomson, Simon; O’Callaghan, J.R.; Eisenberg, Elon; Milbouw, G; Buchser, Eric; Fortini, Gianpaolo; Richardson, Jonathan; North, Richard B.

doi:10.1227/01.neu.0000325731.46702.d9

Cited by 566 publications

(164 citation statements)

References 24 publications

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“…Анальгезия, вызываемая SCS, длится в течение не-которого времени после прекращения стимуляции, причем в некоторых случаях это время оказывается су-щественно более длительным, чем можно объяснить последействием системы воротного контроля [48,49]. Механизм такой послестимуляционной анальгезии до-стоверно установить пока не удалось.…”

Section: механизм действия и прямые эффекты спинальной нейростимуляцииunclassified

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

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Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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Section: механизм действия и прямые эффекты спинальной нейростимуляцииunclassified

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

View full text Add to dashboard Cite

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“…However, an estimated 30–50% of patients receiving permanent SCS fail to achieve and/or maintain a 50% reduction in pain intensity on the Visual Analog Scale (VAS), indicating that a subset of patients may benefit from technological developments in SCS therapy 2, 3, 4.…”

Section: Introductionmentioning

confidence: 99%

Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study

Courtney¹,

Espinet²,

Mitchell

et al. 2015

Neuromodulation: Technology at the Neural Interface

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ObjectivesConventional spinal cord stimulation (SCS) delivers a tonic waveform with consistent stream of pulses; burst delivers groups of pulses separated by short pulse‐free periods. The current study compared the short‐term safety and efficacy of burst with tonic stimulation in subjects already receiving SCS.Materials and MethodsAt 4 IRB‐approved sites, 22 subjects previously implanted with an SCS device for intractable, chronic pain gave informed consent and received burst stimulation for 14 days. Subjects reported average daily Visual Analog Scale (VAS) for overall, trunk, and limb pain using tonic stimulation and after 7 and 14 days of burst stimulation. Thoughts about pain were assessed using the Pain Catastrophizing Scale. Areas of paresthesia were assessed during tonic and burst stimulation using body maps. Assessment of patient satisfaction and preferred stimulation occurred after 14 days of burst.ResultsAverage daily overall VAS reduced 46% from a mean of 53.5 (±20.2) mm during tonic SCS to 28.5 (±18.1) mm during burst (p < 0.001); trunk and limb VAS scores were also reduced by 33% and 51%, respectively. During burst, 16 subjects (73%) reported no paresthesia, 5 (23%) reported a reduction, and 1 (4%) reported increased paresthesia. After 14 days, 21 subjects (95%) reported being very satisfied or satisfied with burst. Burst was preferred by 20 subjects (91%), tonic by 1 (5%), and 1 (5%) reported no preference. Better pain relief was the most common reason cited for preference.ConclusionsA majority of subjects reported improved pain relief using burst compared with tonic stimulation. Most subjects experienced less paresthesia during burst and preferred burst citing better pain relief.

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“…The improvement of pain is paralleled by increased quality of life, reduced need for analgesic medication and the reduction of physical disability [3,7,9,16]. Long-term results with stable improvement have been reported in various studies [3,7,9,16,18]. The electrodes are placed in the posterior epidural space in the lower thoracic spine, and more rarely in the cervical spine depending on the body region affected by neuropathic pain and the site of the nerve lesion [19,20,21].…”

Section: Discussionmentioning

confidence: 99%

Cervical Myelopathy due to an Epidural Cervical Mass after Chronic Cervical Spinal Cord Stimulation

Wloch¹,

Capelle²,

Saryyeva³

et al. 2013

Stereotact Funct Neurosurg

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Background: Spinal cord stimulation (SCS) is an established treatment for neuropathic pain. Severe long-term complications are rare. Only recently secondary mass lesions associated with chronic stimulation were noted to occur. Objectives: To report the rare occurrence of cervical myelopathy secondary to an epidural cervical spinal mass after chronic cervical SCS. Methods: Implantation of a paddle electrode at C2-C4 for chronic neuropathic pain resulted in improvement of pain for several years but it lost its efficacy after 8 years. Myelography and postmyelographic CT detected an epidural mass surrounding the electrode and compressing the spinal cord when cervical myelopathy had developed 17 years after electrode implantation. Results: The mass which consisted of dense fibrous scar tissue was removed via hemilaminectomy. At postoperative follow-up at 8 months there was no further progression of gait disorder. Conclusion: Long-term cervical SCS in a rare case may lead to fibrous epidural mass lesions which may not only cause loss of efficacy but which may also result in new neurological deficits.

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The Effects of Spinal Cord Stimulation in Neuropathic Pain Are Sustained

Abstract: At 24 months of SCS treatment, selected failed back surgery syndrome patients reported sustained pain relief, clinically important improvements in functional capacity and health-related quality of life, and satisfaction with treatment.

Cited by 566 publications

References 24 publications

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study

Cervical Myelopathy due to an Epidural Cervical Mass after Chronic Cervical Spinal Cord Stimulation

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