Waves of Pain Relief: A Systematic Review of Clinical Trials in Spinal Cord Stimulation Waveforms for the Treatment of Chronic Neuropathic Low Back and Leg Pain

Head, Jeffery; Mazza, Jacob; Sabourin, Victor; Turpin, Justin; Hoelscher, Christian; Wu, Chengyuan; Sharan, Ashwini

doi:10.1016/j.wneu.2019.07.167

Cited by 33 publications

(13 citation statements)

References 35 publications

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“…The Senza SCS system has already been approved by the FDA in the management of chronic intractable pain of the trunk or limbs associated with failed back surgery syndrome or intractable low back or leg pain. Prior systematic reviews support the use of any SCS in this particular indication; however, they have also found evidence suggesting that 10 kHz SCS devices demonstrate more favorable outcomes relative to traditional devices [41][42][43][44][45][46]. More specifically, the reviews by Vallejo et al and Conger et al found similar values for the percentage of patients who experienced C 50% reduction in pain following 10 kHz SCS as estimated in the current meta-analysis on those with upper limb or neck pain (i.e., 83% [95% CI 77-89%]) [41,46].…”

Section: Efficacy Of Cervical 10 Khz Scsmentioning

confidence: 98%

Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

et al. 2021

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Background: Chronic pain in head, neck, shoulders and upper limbs is debilitating, and patients usually rely on pain medications or surgery to manage their symptoms. However, given the current opioid epidemic, non-pharmacological interventions that reduce pain, such as spinal cord stimulation (SCS), are needed. The purpose of this study was to review the evidence on paresthesia-free 10 kHz SCS therapy for neck and upper extremity pain.Methods: Systematic literature search was performed for studies reporting outcomes for cervical 10 kHz SCS using date limits from May 2008 to November 2020. The study results were analyzed and described qualitatively. Additionally, when feasible, meta-analyses of the outcome data, with 95% confidence intervals (CIs), were conducted using both the fixed-effects (FE) and random-effects (RE) models. Results: A total of 15 studies were eligible for inclusion. The proportion of patients who achieved C 50% pain reduction was 83% (95% CI 77-89%) in both the FE and RE models. The proportion of patients who reduced/eliminated their opioid consumption was 39% (95% CI 31-46%) in the FE model and 39% (95% CI 31-48%) in the RE model. Pain or discomfort with the implant, lead migration, and infections were potential risks following cervical SCS. Explant rate was 0.1 (95% CI 0.0-0.2) events per 100 person-months, and no patients in the included studies experienced a neurological complication or paresthesia. Conclusion: Findings suggest 10 kHz SCS is a promising, safe, minimally invasive alternative for managing chronic upper limb and neck pain.

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Section: Efficacy Of Cervical 10 Khz Scsmentioning

confidence: 98%

Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

et al. 2021

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“…The stimulator delivers electrical pulses in pre-determined patterns established by parameters such as pulse-width, frequency and amplitude. Whilst its mechanisms of analgesic action are not well understood [1,2], increasing evidence from clinical trials support its analgesic efficacy in what can be a severely debilitating and distressing condition [1,3]. ECT is an antidepressant intervention which involves the passage of an electrical current through pre-determined electrode configurations placed on the recipient's scalp to induce a seizure.…”

Section: To the Editormentioning

confidence: 99%

Safe and successful treatment of depression with electroconvulsive therapy in a patient with implanted spinal cord stimulators

et al. 2020

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“…The etiology of neuropathic pain is complex and includes diabetic neuropathy, spinal cord injury, post-herpetic neuralgia, demyelinating disease, and cancer. In the past, various therapies for neuropathic pain, including pharmacotherapy [4], nerve block [5], spinal cord simulation [6], neurosurgical lesioning, and surgery [7], have been used. However, these treatment methods are not fully effective in relieving neuropathic pain.…”

Section: Introductionmentioning

confidence: 99%

Anti-inflammatory protein TSG-6 secreted by bone marrow mesenchymal stem cells attenuates neuropathic pain by inhibiting the TLR2/MyD88/NF-κB signaling pathway in spinal microglia

Yang

Deng

et al. 2020

J Neuroinflammation

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Background: Neuroinflammation plays a vital role in the development and maintenance of neuropathic pain. Recent evidence has proved that bone marrow mesenchymal stem cells (BMSCs) can inhibit neuropathic pain and possess potent immunomodulatory and immunosuppressive properties via secreting a variety of bioactive molecules, such as TNF-α-stimulated gene 6 protein (TSG-6). However, it is unknown whether BMSCs exert their analgesic effect against neuropathic pain by secreting TSG-6. Therefore, the present study aimed to evaluate the analgesic effects of TSG-6 released from BMSCs on neuropathic pain induced by chronic constriction injury (CCI) in rats and explored the possible underlying mechanisms in vitro and in vivo. Methods: BMSCs were isolated from rat bone marrow and characterized by flow cytometry and functional differentiation. One day after CCI surgery, about 5 × 10 6 BMSCs were intrathecally injected into spinal cerebrospinal fluid. Behavioral tests, including mechanical allodynia, thermal hyperalgesia, and motor function, were carried out at 1, 3, 5, 7, 14 days after CCI surgery. Spinal cords were processed for immunohistochemical analysis of the microglial marker Iba-1. The mRNA and protein levels of pro-inflammatory cytokines (IL-1β, TNFα, IL-6) were detected by realtime RT-PCR and ELISA. The activation of the TLR2/MyD88/NF-κB signaling pathway was evaluated by Western blot and immunofluorescence staining. The analgesic effect of exogenous recombinant TSG-6 on CCI-induced mechanical allodynia and heat hyperalgesia was observed by behavioral tests. In the in vitro experiments, primary cultured microglia were stimulated with the TLR2 agonist Pam3CSK4, and then co-cultured with BMSCs or recombinant TSG-6. The protein expression of TLR2, MyD88, p-p65 was evaluated by Western blot. The mRNA and protein levels of IL-1β, TNFα, IL-6 were detected by real-time RT-PCR and ELISA. BMSCs were transfected with the TSG-6-specific shRNA and then intrathecally injected into spinal cerebrospinal fluid in vivo or co-cultured with Pam3CSK4-treated primary microglia in vitro to investigate whether TSG-6 participated in the therapeutic effect of BMSCs on CCI-induced neuropathic pain and neuroinflammation.

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Waves of Pain Relief: A Systematic Review of Clinical Trials in Spinal Cord Stimulation Waveforms for the Treatment of Chronic Neuropathic Low Back and Leg Pain

Cited by 33 publications

References 35 publications

Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

Safe and successful treatment of depression with electroconvulsive therapy in a patient with implanted spinal cord stimulators

Anti-inflammatory protein TSG-6 secreted by bone marrow mesenchymal stem cells attenuates neuropathic pain by inhibiting the TLR2/MyD88/NF-κB signaling pathway in spinal microglia

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