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

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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Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

Pain Management ◽

10.2217/pmt-2020-0016 ◽

2020 ◽

Author(s):

Awinita Barpujari ◽

Michael A Erdek

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Retrospective Analysis ◽

Spinal Cord Stimulation ◽

Alternative Therapy ◽

Opioid Consumption ◽

Opioid Use ◽

Number Of Patients ◽

Chronic Pain Conditions ◽

Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

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Proteomic analysis of cerebrospinal fluid gives insight into the pain relief of spinal cord stimulation

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2013.07.010 ◽

2013 ◽

Vol 4 (4) ◽

pp. 257-258 ◽

Cited By ~ 1

Author(s):

Anne-Li Lind ◽

Magnus Wetterhall ◽

Marcus Sjödin ◽

Torsten Gordh

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Neuropathic Pain ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Statistical Tests ◽

Cost Effective ◽

Structural Similarity ◽

Cost Effective Treatment ◽

Pain Patients

AbstractAimsNeuropathic pain is caused by a lesion or disease of the somatosensory nervous system affecting approximately 2% of the population. Current pharmacological treatments are ineffective for more than 50% of the patients and often give much adverse effects. Spinal cord stimulation (SCS) is an alternative cost-effective treatment with high efficacy, prolonged pain relief, few side effects. We have compared the cerebrospinal fluid (CSF) proteomes from neuropathic pain patients during pain relief induced by SCS and during pain sensation without SCS, to gain further insights into the mechanisms behind the obtained analgesia.MethodsPaired CSF samples were taken from SCS-responsive neuropathic pain patients after the SCS had been turned off for 48 h and when the SCS had been used normally for three weeks. Thus, each patient acted as their own control. The corresponding proteomes for each patient were relatively quantified using a mass spectrometry based shotgun approach.ResultsIn total, 419 unique proteins were simultaneously identified and relatively quantified. A panel consisting of seven proteins, 5 up-regulated and 2 down, were found to be significantly regulated by SCS in two complementary statistical tests (P ≤ 0.01). The most up-regulated protein in the SCS linked panel is a known modulator of nicotinic acetylcholine (ACh) receptor activity. Interestingly, it has a striking tertiary structural similarity and biological functionality as pain modulating prototoxins found in snake venoms.ConclusionsOur findings reveal possible insights into the mechanism of spinal cord stimulation and the obtained pain relief.

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Modulation of the Somatosensory Evoked Potential by Attention and Spinal Cord Stimulation

Frontiers in Neurology ◽

10.3389/fneur.2021.694310 ◽

2021 ◽

Vol 12 ◽

Author(s):

Guiomar Niso ◽

Marleen C. Tjepkema-Cloostermans ◽

Mathieu W. P. M. Lenders ◽

Cecile C. de Vos

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Brain Activity ◽

Explorative Study ◽

Brain Responses ◽

Chronic Pain Patients ◽

Electrical Pulses ◽

Pain Patients

Introduction: Spinal Cord Stimulation (SCS) is a last-resort treatment for patients with intractable chronic pain in whom pharmacological and other treatments have failed. Conventional tonic SCS is accompanied by tingling sensations. More recent stimulation protocols like burst SCS are not sensed by the patient while providing similar levels of pain relief. It has been previously reported that conventional tonic SCS can attenuate sensory-discriminative processing in several brain areas, but that burst SCS might have additional effects on the medial, motivational-affective pain system. In this explorative study we assessed the influence of attention on the somatosensory evoked brain responses under conventional tonic SCS as well as burst SCS regime.Methods: Twelve chronic pain patients with an implanted SCS device had 2-weeks evaluation periods with three different SCS settings (conventional tonic SCS, burst SCS, and sham SCS). At the end of each period, an electro-encephalography (EEG) measurement was done, at which patients received transcutaneous electrical pulses at the tibial nerve to induce somatosensory evoked potentials (SEP). SEP data was acquired while patients were attending the applied pulses and while they were mind wandering. The effects of attention as well as SCS regimes on the SEP were analyzed by comparing amplitudes of early and late latencies at the vertex as well as brain activity at full cortical maps.Results: Pain relief obtained by the various SCS settings varied largely among patients. Early SEP responses were not significantly affected by attention nor SCS settings (i.e., burst, tonic, and sham). However, late SEP responses (P300) were reduced with tonic and burst SCS: conventional tonic SCS reduced P300 brain activity in the unattended condition, while burst SCS reduced P300 brain activity in both attended and unattended conditions.Conclusion: Burst spinal cord stimulation for the treatment of chronic pain seems to reduce cortical attention that is or can be directed to somatosensory stimuli to a larger extent than conventional spinal cord stimulation treatment. This is a first step in understanding why in selected chronic pain patients burst SCS is more effective than tonic SCS and how neuroimaging could assist in personalizing SCS treatment.

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Long-term efficacy of 1–1.2 kHz subthreshold spinal cord stimulation following failed traditional spinal cord stimulation: a retrospective case series

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000003 ◽

2019 ◽

Vol 44 (1) ◽

pp. 107-110 ◽

Cited By ~ 7

Author(s):

Leonardo Kapural ◽

Shervin Harandi

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Case Series ◽

Low Frequency ◽

Opioid Use ◽

Retrospective Case ◽

Pain Scores ◽

Significant Difference

Background and objectiveWe investigated whether an effective long-term pain relief could be achieved using subthreshold 1–1.2 kHz spinal cord stimulation (SCS) among patients who were initially implanted with traditional paresthesia-based SCS but who failed to maintain an adequate pain relief.MethodsRetrospective chart review was conducted of patients’ electronic records who underwent a trial of subthreshold 1–1.2 kHz SCS. One hundred and nine patients implanted and programmed at traditional paresthesia-based frequencies 40–90 Hz (low-frequency SCS) with unsatisfactory pain relief or unpleasant paresthesias were identified. Patients’ settings were switched to 1–1.2 kHz and 60–210 µs, and variable amplitude adjusted to subthreshold. Pain scores and medication usage were collected. Complete data are presented on 95 patients.ResultsData were collected from 36 men and 59 women who were converted from above-threshold 40–90 Hz SCS to 1–1.2 kHz SCS, with a minimum follow-up of 12 months. Nearly a third (63/95 or 66.3%) of the subjects deemed 1–1.2 kHz SCS ineffective and returned to low-frequency SCS within 1 week after switch, and one-sixth (16/95 or 16.8%) of the subjects returned to low-frequency SCS within 1 month. Only 13 (13.7%) subjects continued using 1–1.2 kHz subthreshold SCS for 3 months or longer and 2.1% (2/95) of subjects continued using it at 12 months. A comparison of their pain scores and opioid use before and during the time we used 1–1.2 kHz SCS revealed no significant difference.ConclusionThe results from our single center failed to show additional long-term clinical benefit of 1–1.2 kHz subthreshold SCS in patients with chronic pain failing traditional low-frequency SCS.

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

Neurosurgery ◽

10.1093/neuros/nyz495 ◽

2019 ◽

Vol 87 (2) ◽

pp. 176-185 ◽

Cited By ~ 17

Author(s):

Kasra Amirdelfan ◽

Ricardo Vallejo ◽

Ramsin Benyamin ◽

Cong Yu ◽

Thomas Yang ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Neck Pain ◽

Upper Limb ◽

Spinal Cord Stimulation ◽

Limb Pain ◽

Arm Pain ◽

System A ◽

Institutional Review ◽

Upper Limb Pain

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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Spinal Cord Stimulation for Relief of Chronic Pain in Vasospastic Disorders of the Upper Limbs

Neurosurgery ◽

10.1227/00006123-198901000-00010 ◽

1989 ◽

Vol 24 (1) ◽

pp. 63-67 ◽

Cited By ~ 89

Author(s):

Francisco J. Robaina ◽

Manuel Dominguez ◽

Manuel Díaz ◽

José L. Rodriguez ◽

José A. de Vera

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Reflex Sympathetic Dystrophy ◽

Mcgill Pain Questionnaire ◽

Primary Therapy ◽

Upper Limbs ◽

Raynaud's Disease ◽

Raynaud’S Disease

Abstract Eleven patients with chronic pain due to severe vasospastic disorders in the upper limbs were treated with cervical spinal cord stimulation. In 8 patients the pain was due to reflex sympathetic dystrophy in the late stage of the disease, and 3 patients had severe idiopathic Raynaud's disease. The mean follow-up for both groups was 27 months. A total of 10 patients (90.9%) had good or excellent results. Thermographic and plethysmographic changes were observed in both groups. There seems to be a very close relationship between the increase of blood flow and the amount of pain relief achieved. In an attempt to quantify the intensity of pain, the visual analog scale and McGill Pain Questionnaire were used, Stimulation proved to be harmless, with no mortality and very low morbidity. The latter centered around local infection and displacement of the electrodes. No objective changes occurred in trophic alterations such as bone decalcification and ankylosis, but there were improvements in the alterations in the nails and skin. In the reflex sympathetic dystrophy group, the amount of pain relief achieved enabled most patients to undergo subsequent physiotherapy and rehabilitation. In severe cases of reflex sympathetic dystrophy and idiopathic Raynaud's disease, spinal cord stimulation is an alternative treatment that can be used as primary therapy or as secondary therapy after unsuccessful sympathectomy or sympathetic blocks.

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UTILIZATION OF MULTIPLE SPINAL CORD STIMULATION WAVEFORMS IN CHRONIC PAIN PATIENTS

10.26226/morressier.598b05d9d462b80290b536d3 ◽

2017 ◽

Author(s):

Roshini Jain

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Spinal Cord Stimulation ◽

Chronic Pain Patients ◽

Pain Patients

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Spinal Cord Stimulation for Relief of Chronic Pain in Vasospastic Disorders of the Upper Limbs

Survey of Anesthesiology ◽

10.1097/00132586-198910000-00042 ◽

1989 ◽

Vol 5 (2) ◽

pp. 312

Author(s):

F. J. ROBAINA ◽

M. DOMINGUEZ ◽

M. DIAZ ◽

J. L. RODRIGUEZ ◽

J. A. DE VERA

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Spinal Cord Stimulation ◽

Upper Limbs

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Spinal Cord Stimulation: A Contemporary Series

Neurosurgery ◽

10.1227/00006123-199101000-00011 ◽

1991 ◽

Vol 28 (1) ◽

pp. 65-71 ◽

Cited By ~ 78

Author(s):

Roberto Spiegelmann ◽

William A. Friedman

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Literature Review ◽

General Anesthesia ◽

Detailed Analysis ◽

Spinal Cord Stimulation ◽

Significant Pain ◽

Experience Pain

Abstract Forty-three patients with chronic pain disorders of different causes were selected for spinal cord stimulation. All underwent implantation of a ribbon electrode through a small laminotomy, under general anesthesia. Thirteen patients (30%) failed to obtain significant pain relief during a period of trial stimulation, and their electrodes were removed. The remainder underwent a definitive implant and were followed for a mean of 13 months (range, 3-33 months). Nineteen of them (63%) continued to experience pain relief. A detailed analysis of this series, as well as a literature review, is presented.

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