scholarly journals Spinal Cord Stimulation as Treatment for Cancer and Chemotherapy-Induced Pain

2021 ◽  
Vol 2 ◽  
Author(s):  
Breanna L. Sheldon ◽  
Jonathan Bao ◽  
Olga Khazen ◽  
Julie G. Pilitsis
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Health Care Systems ◽  
Phantom Limb Pain ◽  
Pain Syndrome ◽  
Cost Effective ◽  
Failed Back Surgery Syndrome ◽  
Phantom Limb ◽  
Failed Back Surgery

Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.

Defining minimal clinically important differences in pain and disability outcomes of patients with chronic pain treated with spinal cord stimulation

2021 ◽  
pp. 1-8
Author(s):  
Shelby Sabourin ◽  
Justin Tram ◽  
Breanna L. Sheldon ◽  
Julie G. Pilitsis
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Catastrophizing ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Mcgill Pain Questionnaire ◽  
Minimum Detectable Change ◽  
Failed Back Surgery

OBJECTIVE Minimal clinically important difference (MCID) thresholds for a limited number of outcome metrics were previously defined for patients with failed back surgery syndrome (FBSS) at 6 months after spinal cord stimulation (SCS). This study aimed to further define MCID values for pain and disability outcomes. Additionally, the authors established 1-year MCID values for outcome measures with previously defined metrics commonly used to assess SCS efficacy. METHODS Preoperative and 1-year postoperative outcomes were collected from 114 patients who received SCS therapy for FBSS, complex regional pain syndrome, and neuropathic pain. MCID values were established for the numerical rating scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), McGill Pain Questionnaire (MPQ), and Pain Catastrophizing Scale (PCS). Four established anchor-based methods were utilized to compute MCID values with two anchored questions: “Are you satisfied with SCS therapy?” and “Would you have SCS surgery again?” For each question, patients were categorized as responders if they answered “yes” or as nonresponders if they responded “no.” The methodologies utilized to compute MCID scores included the average change method, minimum detectable change approach, change difference calculation, and receiver operating characteristic (ROC) analysis. Area under the ROC curve (AUC) analysis has been shown to inform the accuracy at which the MCID value can distinguish responders from nonresponders and was analyzed for each instrument. RESULTS For the first time, ranges of MCID values after SCS were established for MPQ (1–2.3) and PCS (1.9–13.6). One-year MCID values were defined for all indications: NRS (range 0.9–2.7), ODI (3.5–6.9), and BDI (2–5.9). AUC values were significant for NRS (0.78, p < 0.001), ODI (0.71, p = 0.003), MPQ (0.74, p < 0.001), and PCS (0.77, p < 0.001), indicating notable accuracy for distinguishing satisfied patients. CONCLUSIONS This was the first study to successfully determine MCID values for two prominent instruments, MPQ and PCS, used to assess pain after SCS surgery. Additionally, previously established MCID values for ODI, BDI, and the visual analog scale for patients with FBSS at 6 months after treatment were explored at 12 months for the most common indications for SCS. These data may better inform physicians of patient response to and success with SCS therapy.

scholarly journals Complex Regional Pain Syndrome and Failed Back Surgery Syndrome With Failed High-Frequency Spinal Cord Stimulation Salvaged With Arthrodesis Revision Surgery and Burst Therapy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Erin McCormack ◽  
Mansour H Mathkour ◽  
Lora Wallis Kahn ◽  
Maged Guirguis ◽  
Gassan Chaiban ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Relief ◽  
High Frequency ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Foot Pain ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract INTRODUCTION Complex regional pain syndrome (CRPS) is a disabling form of constant and intense chronic pain involving a limb. Failed back surgery syndrome (FBSS) is chronic back pain following back surgery. Burst stimulation is a novel concept applied recently to treat chronic pain through spinal cord stimulation (SCS). The impulses are thought to travel to the thalamus to treat sensory, affective, and attentional components of neuropathic pain by targeting both the somatosensory cortex and the limbic system. METHODS A 50-yr-old female presented 1 yr after L5-S1 posterior instrumentation and posterolateral arthrodesis for spondylolisthesis with disabling Type I CRPS of her left foot and back pain. Postoperative improvement in back pain was noted but her left leg pain became worse despite SCS reprogramming. Two months later, she underwent placement of a different paddle lead at T12 and a new pulse generator using burst therapy. This resulted in complete resolution of foot pain. She remains pain-free 5 mo postoperatively. RESULTS Our patient underwent a T9-T10 high frequency (10 kHz) SCS trial followed by permanent paddle lead placement at T9-10 which provided more than 50% foot pain relief resulting in improved range of motion. However, worsening back pain and pseudoarthrosis mandated a revision of her prior arthrodesis 6 mo after SCS surgery. CONCLUSION In selected patients with FBSS and CRPS, revision of arthrodesis combined with SCS may be needed to achieve adequate pain relief. Burst therapy may be superior to high frequency stimulation in select patients.

Application of spinal cord stimulation in the treatment of persistent pain in failed back surgery syndrome

2018 ◽  
Vol 20 (2) ◽  
pp. 43-49
Author(s):  
A. В. Dmitriev ◽  
D. A. Rzaev ◽  
N. P. Denisova
Keyword(s):  
Spinal Cord ◽  
Hospital Discharge ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Drug Resistant ◽  
Neurogenic Pain ◽  
Study Objective ◽  
Failed Back Surgery ◽  
Back Surgery

The study objectiveis to demonstrate our experience of the spinal cord stimulation in the treatment of drug-resistant pain in patients with the failed back surgery syndrome (FBSS) and to evaluate its effectiveness and complications.Materials and methods.Systems for chronic spinal cord stimulation were implanted in 78 patients suffering from FBSS in Federal Neurosurgical Center (Novosibirsk) during 2013–2015. All patients had a drug-resistant neurogenic pain syndrome character and were undergone surgical intervention on the spine. Evaluating of the treatment effectiveness was carried out by visual analogue scale (VAS) and a scale Douleur Neuropathique en 4 Questions (DN4). Catamnesis ranged from 6 to 18 months.Results.The median preoperative VAS score evaluation was 6.7, at hospital discharge – 3.1, after 6 months – 3.2, after 12 months – 3.5, after 18 months – 3.4. Evaluation on a scale DN4 before surgery was 5.3, at hospital discharge – 2.1, after 6 months – 2.4, after 12 months – 2.5, after 18 months – 2.4. Complications in the form of migration, fracture of the electrodes and development of hemorrhage or inflammation at the site of implantation of the system were observed in 12 (15.3 %) cases and required revision surgery.Conclusion.Spinal stimulation is an effective and safe method of treatment of pain in FBSS, but it has specific complications associated with implantable systems.

scholarly journals Effects of Movement and Postural Positions in Spinal Cord Stimulation in the New Rechargeable Systems

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E345-E352
Author(s):  
David Abejón
Keyword(s):  
Spinal Cord ◽  
Therapeutic Range ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Failed Back Surgery Syndrome ◽  
Constant Current ◽  
Perception Threshold ◽  
Patients Satisfaction ◽  
Postural Changes ◽  
Failed Back Surgery

Background: Despite recent developments in implantable neurostimulation devices, the adjustment of stimulation levels to the patient’s postural changes has remained a problem so far. Objective: This study was conducted with the newest rechargeable devices, in order to compare its results with the ones published from conventional systems. Study Design: It is a prospective study. Setting: In 46 patients implanted with rechargeable constant current stimulation systems we measured impedance, stimulation thresholds, therapeutic range, as well patients’ satisfaction and sensation in 7 different body postures. Results: Data analysis was performed in 46 patients, whose most frequent pathologies were failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). The lowest amplitude needed to reach the different thresholds was always scored in the supine decubitus position, with no significant changes in the therapeutic range and impedance. For all stimulation thresholds, there is always a difference between the supine position and all other postures. No statistically significant differences with regard to patients’ satisfaction and sensation were found for the different postures. Limitations: Sample sample size. Conclusion: The findings of the present work are similar to those described in previous publications that showed the relationship between postural changes and several stimulation thresholds and pulse energy. The posture which requires lower energy — and whose corresponding therapeutic range (TR) is narrower — is supine decubitus. Key words: Spinal cord stimulation, change posture, rechargeable systems, sensor generation, threshold perception, threshold discomfort

scholarly journals Wireless High-Frequency Spinal Cord Stimulation (10 kHz) Compared with Multiwaveform Low-Frequency Spinal Cord Stimulation in the Management of Chronic Pain in Failed Back Surgery Syndrome Subjects: Preliminary Results of a Multicenter, Prospective Randomized Controlled Study

Pain Medicine ◽  
2019 ◽  
Vol 20 (10) ◽  
pp. 1971-1979 ◽  
Author(s):  
Robert Bolash ◽  
Michael Creamer ◽  
Richard Rauck ◽  
Payam Vahedifar ◽  
Aaron Calodney ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Low Frequency ◽  
Failed Back Surgery Syndrome ◽  
Leg Pain ◽  
Trial Period ◽  
Failed Back Surgery ◽  
Back Surgery

Abstract Background This study aimed to evaluate the wireless Freedom Spinal Cord Stimulator (WSCS) System for the treatment of chronic back and/or leg pain associated with failed back surgery syndrome (FBSS) refractory to standard medical treatment utilizing 10-kHz stimulation (high-frequency [HF]) in comparison with 10–1,500-Hz stimulation (low-frequency [LF]) waveforms. Methods Ninety-nine subjects were randomized in a 1:1 ratio to receive either HF or LF stimulation waveforms utilizing the same Freedom WSCS System. All subjects were implanted with two 8-electrode arrays in the exact same anatomical positions within the dorsal epidural spinal column, with the top electrode positioned at the T8 and T9 vertebrae levels, respectively, and the wireless receiver placed under the skin in a subcutaneous pocket. Results Seventy-two (HF: N = 38; LF: N = 34) subjects had completed the six-month follow-up after an initial 30-day trial period at the time of this report. For both the HF and LF arms, mean visual analog scale (VAS) scores for back and leg pain decreased significantly: 77% and 76%, respectively, for the HF arm and 64% and 64%, respectively, for the LF arm. In addition, most subjects experienced significant improvements in VAS, Oswestry Disability Index, European Quality of Life 5 Dimension questionnaire, Patient Global Impression of Change, and sleep duration. Conclusions These preliminary results demonstrate that WSCS devices can reduce FBSS chronic pain substantially with both LF and HF stimulation waveforms over a seven-month period (30-day trial period and six-month post-trial evaluation).

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