High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Combined Neck and Arm Pain: Results From a Prospective Multicenter Study

Abstract BACKGROUND Intractable neck and upper limb pain has historically been challenging to treat with conventional spinal cord stimulation (SCS) being limited by obtaining effective paresthesia coverage. OBJECTIVE To assess the safety and effectiveness of the 10-kHz SCS system, a paresthesia-independent therapy, in the treatment of neck and upper limb pain. METHODS Subjects with chronic, intractable neck and/or upper limb pain of ≥5 cm (on a 0-10 cm visual analog scale [VAS]) were enrolled in 6 US centers following an investigational device exemption from the Food and Drug Administration (FDA) and institutional review board approval. Each subject was implanted with 2 epidural leads spanning C2-C6 vertebral bodies. Subjects with successful trial stimulation were implanted with a Senza® system (Nevro Corp) and included in the evaluation of the primary safety and effectiveness endpoints. RESULTS In the per protocol population, the primary endpoint (≥50% pain relief at 3 mo) was achieved in 86.7% (n = 39/45) subjects. Compared to baseline, subjects reported a significant reduction (P < .001) in their mean (± standard error of the mean) VAS scores at 12-mo assessment for neck pain (7.6 ± 0.2 cm, n = 42 vs 1.5 ± 0.3 cm, n = 37) and upper limb pain (7.1 ± 0.3 cm, n = 24 vs 1.0 ± 0.2 cm, n = 20). At 12-mo assessment, 89.2% of subjects with neck pain and 95.0% with upper limb pain had ≥50% pain relief from baseline, 95.0% reported to be “satisfied/very satisfied” and 30.0% either eliminated or reduced their opioid intake. CONCLUSION In conclusion, 10-kHz SCS can treat intractable neck and upper limb pain with stable long-term outcomes.

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Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

Journal of International Medical Research ◽

10.1177/03000605211004035 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052110040

Author(s):

Kuen Su Lee ◽

Yoo Kyung Jang ◽

Gene Hyun Park ◽

In Jae Jun ◽

Jae Chul Koh

Keyword(s):

Spinal Cord ◽

Upper Limb ◽

Spinal Cord Stimulation ◽

Therapeutic Potential ◽

Case Series ◽

Limb Amputation ◽

Intractable Pain ◽

Limb Pain ◽

Cord Injury ◽

Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

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Multicentre, clinical trial of burst spinal cord stimulation for neck and upper limb pain NU-BURST: a trial protocol

Neurological Sciences ◽

10.1007/s10072-020-04907-3 ◽

2021 ◽

Author(s):

Adnan Al-Kaisy ◽

Girish Vajramani ◽

Sarah Love-Jones ◽

Nikunj K. Patel ◽

Jonathan Royds ◽

...

Keyword(s):

Clinical Trial ◽

Spinal Cord ◽

Upper Limb ◽

Spinal Cord Stimulation ◽

Trial Protocol ◽

Limb Pain ◽

Multicentre Clinical Trial ◽

Upper Limb Pain

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Pain relief and opioid usage in upper limb and neck pain patients after 10-kHz spinal cord stimulation treatment: subanalysis of USA studies

Pain Management ◽

10.2217/pmt-2020-0074 ◽

2020 ◽

Author(s):

Kasra Amirdelfan ◽

Ricardo Vallejo ◽

Ramsin Benyamin ◽

Steven Rosen ◽

Peter Kosek ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Neck Pain ◽

Spinal Cord Stimulation ◽

Opioid Consumption ◽

Upper Limbs ◽

Opioid Use ◽

Scale Scores ◽

Post Hoc ◽

Pain Patients

Aim: It is argued that chronic pain patients who reduce/eliminate their opioids may have compromised pain relief. This study therefore aimed to analyze if reduced opioid consumption associated with 10-kHz spinal cord stimulation adversely affected pain relief. Methods: Post hoc analysis was performed on data from two prospective studies in subjects with upper limbs and neck pain conducted in USA. Results & conclusion: A 10-kHz spinal cord stimulation treatment was associated with reduction in mean visual analog scale scores for upper limbs and neck pain and mean daily opioid consumption. Pain scores decreased in subjects who decreased opioid use and in those who maintained/increased use. Opioid reduction and pain relief was also achieved in subjects taking >90 mg morphine equivalents of opioids at baseline.

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The Prevalence of and Risk Factors for Neck Pain and Upper Limb Pain among Secondary School Teachers in Hong Kong

Journal of Occupational Rehabilitation ◽

10.1007/s10926-006-9046-z ◽

2006 ◽

Vol 17 (1) ◽

pp. 19-32 ◽

Cited By ~ 44

Author(s):

Thomas T. W. Chiu ◽

Peggo K. W. Lam

Keyword(s):

Risk Factors ◽

Hong Kong ◽

Secondary School ◽

Neck Pain ◽

Upper Limb ◽

Secondary School Teachers ◽

School Teachers ◽

Limb Pain ◽

Upper Limb Pain

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Neuromodulation of the Cervical Spinal Cord in the Treatment of Chronic Intractable Neck and Upper Extremity Pain: A Case Series and Review of the Literature

January 2018 - Pain Physician ◽

10.36076/ppj.2007/10/305 ◽

2007 ◽

Vol 2;10 (3;2) ◽

pp. 305-311

Author(s):

Ricardo Vallejo

Keyword(s):

Spinal Cord ◽

Upper Extremity ◽

Spinal Cord Stimulation ◽

Cervical Spinal Cord ◽

Case Series ◽

Low Back ◽

Limb Pain ◽

Fusion Surgery ◽

Upper Limb Pain ◽

Pain Patients

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70–90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. Key words: spinal cord stimulator, cervical, neck pain, radicular pain, axial pain, headache, leg pain

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SPINAL CORD STIMULATION AT 10 KHZ FOR CHRONIC UPPER LIMB AND NECK PAIN: AUSTRALIAN EXPERIENCE

10.26226/morressier.5ab3c87fa874c60026558c9c ◽

2018 ◽

Author(s):

Adele Barnard

Keyword(s):

Spinal Cord ◽

Neck Pain ◽

Upper Limb ◽

Spinal Cord Stimulation ◽

Australian Experience

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Whiplash-associated disorders

10.1093/med/9780199550647.003.012041 ◽

2011 ◽

Author(s):

Rouin Amirfeyz ◽

Simon Kelley ◽

Martin Gargan ◽

Gordon Bannister

Keyword(s):

Back Pain ◽

Neck Pain ◽

Upper Limb ◽

Full Recovery ◽

Limb Pain ◽

Vehicle Collision ◽

Occipital Headache ◽

Upper Limb Pain ◽

Whiplash Associated Disorders

♦ Whiplash costs UK economy approximately £3.64 billion per year♦ Most occur after rear end vehicle collision♦ Patients present with neck pain and stiffness, occipital headache, thoracolumbar back pain and upper limb pain and parasthesia♦ Over 66% make a full recovery but 2% will be permanently disabled♦ The outcome can be predicted in 70% after three months.

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