Factors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate

2007 ◽  
pp. 91-99 ◽  
Author(s):  
Krishna Kumar ◽  
J. R. Wilson
Keyword(s):  
Spinal Cord ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Factors Affecting

Spinal Cord Stimulation in Treatment of Chronic Benign Pain: Challenges in Treatment Planning and Present Status, a 22-Year Experience

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. 481-496 ◽  
Author(s):  
Krishna Kumar ◽  
Gary Hunter ◽  
Denny Demeria
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Pain Clinic ◽  
Axial Component

Abstract OBJECTIVE: To present an in-depth analysis of clinical predictors of outcome including age, sex, etiology of pain, type of electrodes used, duration of pain, duration of treatment, development of tolerance, employment status, activities of daily living, psychological status, and quality of life. Suggestions for treatment of low back pain with a predominant axial component are addressed. We analyzed the complications and proposed remedial measures to improve the effectiveness of this modality. METHODS: Study group consists of 410 patients (252 men, 58 women) with a mean age of 54 years and a mean follow-up period of 97.6 months. All patients were gated through a multidisciplinary pain clinic. The study was conducted over 22 years. RESULTS: The early success rate was 80% (328 patients), whereas the long-term success rate of internalized patients was 74.1% (243 patients) after the mean follow-up period of 97.6 months. Hardware-related complications included displaced or fractured electrodes, infection, and hardware malfunction. Etiologies demonstrating efficacy included failed back syndrome, peripheral vascular disease, angina pain, complex regional pain syndrome I and II, peripheral neuropathy, lower limb pain caused by multiple sclerosis. Age, sex, laterality of pain or number of surgeries before implant did not play a role in predicting outcome. The percentage of pain relief was inversely related to the time interval between pain onset and time of implantation. Radicular pain with axial component responded better to dual Pisces electrode or Specify-Lead implantation. CONCLUSION: Spinal cord stimulation can provide significant long-term pain relief with improved quality of life and employment. Results of this study will be effective in better defining prognostic factors and reducing complications leading to higher success rates with spinal cord stimulation.

Factors Affecting Impedance of Percutaneous Leads in Spinal Cord Stimulation

2006 ◽  
Vol 9 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Kenneth Alò ◽  
Clayton Varga ◽  
Elliot Krames ◽  
Joshua Prager ◽  
Jan Holsheimer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Factors Affecting

scholarly journals Outcomes of Sympathetic Blocks in the Management of Complex Regional Pain Syndrome

2019 ◽  
Vol 131 (4) ◽  
pp. 883-893 ◽  
Author(s):  
Jianguo Cheng ◽  
Vafi Salmasi ◽  
Jing You ◽  
Michael Grille ◽  
Dongsheng Yang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Secondary Outcome ◽  
Predictive Values ◽  
Sympathetic Blocks

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sympathetic dysfunction may be present in complex regional pain syndrome, and sympathetic blocks are routinely performed in practice. To investigate the therapeutic and predictive values of sympathetic blocks, the authors test the hypotheses that sympathetic blocks provide analgesic effects that may be associated with the temperature differences between the two extremities before and after the blocks and that the effects of sympathetic blocks may predict the success (defined as achieving more than 50% pain reduction) of spinal cord stimulation trials. Methods The authors performed a retrospective study of 318 patients who underwent sympathetic blocks in a major academic center (2009 to 2016) to assess the association between pain reduction and preprocedure temperature difference between the involved and contralateral limbs. The primary outcome was pain improvement by more than 50%, and the secondary outcome was duration of more than 50% pain reduction per patient report. The authors assessed the association between pain reduction and the success rate of spinal cord stimulation trials. Results Among the 318 patients, 255 were diagnosed with complex regional pain syndrome and others with various sympathetically related disorders. Successful pain reduction (more than 50%) was observed in 155 patients with complex regional pain syndrome (155 of 255, 61%). The majority of patients (132 of 155, 85%) experienced more than 50% pain relief for 1 to 4 weeks or longer. The degree and duration of pain relief were not associated with preprocedure temperature parameters with estimated odds ratio of 1.03 (97.5% CI, 0.95–1.11) or 1.01 (97.5% CI, 0.96–1.06) for one degree decrease (P = 0.459 or 0.809). There was no difference in the success rate of spinal cord stimulation trials between patients with or without more than 50% pain relief after sympathetic blocks (35 of 40, 88% vs. 26 of 29, 90%, P > 0.990). Conclusions The authors conclude that sympathetic blocks may be therapeutic in patients with complex regional pain syndrome regardless of preprocedure limb temperatures. The effects of sympathetic blocks do not predict the success of spinal cord stimulation.

The Factors Affecting the Difficulty of Percutaneous Cylindrical Electrode Placement for Spinal Cord Stimulation

2018 ◽  
Vol 113 ◽  
pp. e391-e398 ◽  
Author(s):  
Kyohei Kin ◽  
Takashi Agari ◽  
Takao Yasuhara ◽  
Yousuke Tomita ◽  
Ken Kuwahara ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Electrode Placement ◽  
Cylindrical Electrode ◽  
Factors Affecting

scholarly journals Anatomical and technical factors affecting the neural response to epidural spinal cord stimulation

2020 ◽  
Vol 17 (3) ◽  
pp. 036019 ◽  
Author(s):  
Hans J Zander ◽  
Robert D Graham ◽  
Carlos J Anaya ◽  
Scott F Lempka
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Neural Response ◽  
Factors Affecting ◽  
Epidural Spinal Cord Stimulation ◽  
Technical Factors

scholarly journals Improved User Engagement and Assessment of Treatment Effectiveness in Patients Utilizing a Novel Digital Mobile Health Application During Spinal Cord Stimulation Screening Trials (Preprint)

2021 ◽  
Author(s):  
Jennifer M. Lee ◽  
Rex Woon ◽  
Mandy Ramsum ◽  
Daniel Steven Halperin ◽  
Roshini Jain
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Success Rate ◽  
Real Time ◽  
Real World ◽  
Spinal Cord Stimulation ◽  
Activity Level ◽  
User Engagement ◽  
Health Related ◽  
Screening Trial

BACKGROUND Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether or not to proceed with long-term, permanent implantation of an SCS device for treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the particular SCS-based neurostimulative modalities and/or parameters that may provide substantial analgesia in a patient-specific manner. OBJECTIVE In this report, we describe a preliminary, real-world assessment of a new, real-time tracking, smart device-based digital application (app) used by patients with chronic pain undergoing trial screening for SCS therapy. METHODS This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who utilized the new “mySCS” mobile application (Boston Scientific, Valencia, CA) during an SCS screening trial. The app design is HIPAA-compliant and compatible with most commercially available smartphones (e.g., Apple ® iPhone ®, Android ®). The app enables tracking of user-inputted health-related responses (i.e., pain relief, activity level, and/or sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A de-identified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. RESULTS When provided the opportunity, the percentage of users who engaged with the tracking app for ≥50% of the time during their trial was found to be 64.5%. Among those who used the app, ~58% (n = 7795) entered a trial goal(s). Most patients underwent SCS screening with a trial duration of at least 7-days (n = 7739). Of those patients who undertook a 7-day SCS trial, 62.3% engaged the app for 4-days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 78% of patients who reached day 3 of the screening phase assessment and by 83% of those who reached trial completion. A trial success rate of 91% was determined for those who used the app (versus 85% success rate for non-users). CONCLUSIONS Data from this initial, real-world examination of a mobile, digital-health-based tracking application (“mySCS” app), as utilized during the SCS screening phase, demonstrates that substantial patient engagement can be achieved while also providing for the acquisition of more real-time and direct from patient outcome measures that may help facilitate improved SCS trial success.

Complications of spinal cord stimulation, suggestions to improve outcome, and financial impact

2006 ◽  
Vol 5 (3) ◽  
pp. 191-203 ◽  
Author(s):  
Krishna Kumar ◽  
Jefferson R. Wilson ◽  
Rod S. Taylor ◽  
Shivani Gupta
Keyword(s):  
Spinal Cord ◽  
Adverse Events ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Time Course ◽  
Healthcare Resource ◽  
Unit Cost ◽  
Healthcare Budget ◽  
The Cost

Object The long-term success of spinal cord stimulation is impeded by the high incidence of adverse events. The cost of complications to the healthcare budget is influenced by the time course needed to reverse the effect, and by the type of corrective measures required. Understanding the mechanism of complications and reducing them can improve the overall success rate and the cost factor. Methods The authors performed a retrospective analysis of data obtained in 160 patients treated during a 10-year period. For each category of complication, the level of healthcare resource use was assessed for each case and a unit cost was applied. The total cost of each complication was determined by summing across healthcare resource headings. All cost calculations were performed in Canadian dollars at 2005 prices. To understand the mechanics of various hardware-related complications and how to avoid them, the authors have utilized the results of bench tests conducted at Medtronic, Inc. Fifty-one adverse events occurred in 42 of the 160 patients. The complications were classified as either hardware related (39 events) or biological (12 events). The mean cost of complications during the 10-year study period was $7092 (range $130–$22,406). Conclusions Complications not only disrupt the effect of pain control but also pose an added expense to the already high cost of therapy. It is possible to reduce the complication rate, and thus improve the long-term success rate, by following the suggestions made in this paper, which are supported by the biomechanics of the human body and the implanted material.

A Psychoanalytic Investigation to Improve the Success Rate of Spinal Cord Stimulation as a Treatment for Chronic Failed Back Surgery Syndrome

1996 ◽  
Vol 12 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Katty Dumoulin ◽  
Jacques Devulder ◽  
Frédéric Castille ◽  
Martine De Laat ◽  
Martine Van Bastelaere ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Failed Back Surgery Syndrome ◽  
Failed Back Surgery ◽  
Back Surgery
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