Is Impedance a Parameter to be Taken into
Account in Spinal Cord Stimulation?

Background: Over the last few decades, spinal cord stimulation (SCS) has become one of the main treatments in the therapeutic arsenal available to pain treatment units. New stimulation systems have been developed and the indications of neurostimulation have been expanded. The premises for a successful technique remain the same; good patient selection, good surgical technique, and good management of electrical parameters when programming. Design: An observational report. Objectives: The primary objective of the study was to determine the relationship between changes in impedance (R) and energy requirement (E) elicited by changes in patients posture. The postures analyzed were supine (S), sitting (SI), standing (ST), and walking (W). As a second objective, the difference produced in the energy requirement when changing posture was analyzed. Methods: A study was carried out in 70 patients with chronic intractable pain implanted with a neurostimulation system between January 2000 and March 2006. We define the perception threshold (Tp); the discomfort threshold (Td); and the therapeutic threshold (Tt). The amplitude of perception was measured in mA. With the resulting data, the therapeutic range (TR) was determined. After performing all measurements with the patient in the ST position, the neurostimulation system was shut off and the patient maintained in the other position for 5 minutes before performing the measurements. The variables R and E were compared by age groups, sex, implant duration, and the time since implant placement. Patients were divided into groups according to whether the location of the implanted electrodes was cervical or thoracic. The full analysis by age, sex, and implant duration was performed in the cervical and thoracic implant groups. Results: No correlation was found between impedance and posture. When the results for R and E were analyzed by sex and age, no statistical differences were found in any of the values in any position. The analysis of time since implant greater than or less than 6 months did not find differences in the energy requirement, although there was a significant difference in the impedance value when patients were in the S position. No significant differences were observed in the analysis by age groups. Key words: Impedance, posture change, spinal cord stimulation

Download Full-text

The Effect of Pulse Width and Contact Configuration on Paresthesia Coverage in Spinal Cord Stimulation

Neurosurgery ◽

10.1227/neu.0b013e31820b4f47 ◽

2011 ◽

Vol 68 (5) ◽

pp. 1452-1461 ◽

Cited By ~ 26

Author(s):

Jan Holsheimer ◽

Jan R. Buitenweg ◽

John Das ◽

Paul de Sutter ◽

Ljubomir Manola ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pulse Width ◽

Dorsal Column ◽

Intractable Pain ◽

Perception Threshold ◽

Stimulus Pulse ◽

Contact Configuration ◽

Significant Extension ◽

Cervical Stimulation

Abstract BACKGROUND: In spinal cord stimulation for the management of chronic, intractable pain, a satisfactory analgesic effect can be obtained only when the stimulation-induced paresthesias cover all painful body areas completely or partially. OBJECTIVE: To investigate the effect of stimulus pulse width (PW) and contact configuration (CC) on the area of paresthesia (PA), perception threshold (VPT), discomfort threshold (VDT), and usage range (UR) in spinal cord stimulation. METHODS: Chronic pain patients were tested during a follow-up visit. They were stimulated monopolarly and with the CC giving each patient the best analgesia. VPT, VDT, and UR were determined for PWs of 90, 210, and 450 microseconds. The paresthesia contours at VDT were drawn on a body map and digitized; PA was calculated; and its anatomic composition was described. The effects of PW and CC on PA, VPT, VDT, and UR were tested statistically. RESULTS: Twenty-four of 31 tests with low thoracic stimulation and 8 of 9 tests with cervical stimulation gave a significant extension of PA at increasing PW. In 14 of 18 tests (low thoracic), a caudal extension was obtained (primarily in L5-S2). In cervical stimulation the extension was predominantly caudal as well. In contrast to VPT and VDT, UR is not significantly different when stimulating with any CC. CONCLUSION: PA extends caudally with increasing PW. The mechanism includes that the larger and smaller dorsal column fibers have a different mediolateral distribution and that smaller dorsal column fibers have a smaller UR and can be activated only when PW is sufficiently large. A similar effect of CC on PA is unlikely as long as electrodes with a large intercontact distance are applied.

Download Full-text

Spinal Cord Stimulation inpatient with Tethered Cord syndrome: A Case Report

Medical & Clinical Research ◽

10.33140/mcr.05.08.05 ◽

2020 ◽

Vol 5 (8) ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pain Treatment ◽

Case Reports ◽

Tethered Cord ◽

Similar Efficacy ◽

Tethered Cord Syndrome ◽

Intractable Pain ◽

History Of ◽

Myelomeningocele Repair

Background: Neuromodulation techniques are an important part of the chronic refractory neuropathic pain treatment. Their effectiveness is insufficiently documented in patients with tethered cord syndrome. Case Description: We present the case of a 32-year-old woman with a history of myelomeningocele repair, followed by a detethering surgery complicated with cerebral fluid leakage. Her intractable pain in her left leg and low back was successfully treated with spinal cord stimulation. Pain intensity decreased from 8/10 to 1-2/10 on her visual analogue scale without regular analgesic intake and her quality of life improved significantly. Conclusions: A review of the literature documents only three case reports of similar efficacy of spinal cord stimulation in the treatment of pain in adult patients with tethered cord syndrome.

Download Full-text

EXTENDED Palliative (compassionate) medicines for COVID-19

Medical & Clinical Research ◽

10.33140/mcr.05.009 ◽

2020 ◽

Vol 5 (Special) ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pain Treatment ◽

Case Reports ◽

Tethered Cord ◽

Similar Efficacy ◽

Tethered Cord Syndrome ◽

Intractable Pain ◽

History Of ◽

Myelomeningocele Repair

Download Full-text

Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain

Anesthesiology ◽

10.1097/aln.0000000000000774 ◽

2015 ◽

Vol 123 (4) ◽

pp. 851-860 ◽

Cited By ~ 338

Author(s):

Leonardo Kapural ◽

Cong Yu ◽

Matthew W. Doust ◽

Bradford E. Gliner ◽

Ricardo Vallejo ◽

...

Keyword(s):

Spinal Cord ◽

Back Pain ◽

Spinal Cord Stimulation ◽

Pain Treatment ◽

Low Frequency ◽

Leg Pain ◽

Intractable Pain ◽

Limited Effectiveness ◽

Provide Pain Relief

Abstract Background: Current treatments for chronic pain have limited effectiveness and commonly known side effects. Given the prevalence and burden of intractable pain, additional therapeutic approaches are desired. Spinal cord stimulation (SCS) delivered at 10 kHz (as in HF10 therapy) may provide pain relief without the paresthesias typical of traditional low-frequency SCS. The objective of this randomized, parallel-arm, noninferiority study was to compare long-term safety and efficacy of SCS therapies in patients with back and leg pain. Methods: A total of 198 subjects with both back and leg pain were randomized in a 1:1 ratio to a treatment group across 10 comprehensive pain treatment centers. Of these, 171 passed a temporary trial and were implanted with an SCS system. Responders (the primary outcome) were defined as having 50% or greater back pain reduction with no stimulation-related neurological deficit. Results: At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg pain, and 43.8% of traditional SCS subjects were responders for back pain and 55.5% for leg pain (P < 0.001 for both back and leg pain comparisons). The relative ratio for responders was 1.9 (95% CI, 1.4 to 2.5) for back pain and 1.5 (95% CI, 1.2 to 1.9) for leg pain. The superiority of HF10 therapy over traditional SCS for leg and back pain was sustained through 12 months (P < 0.001). HF10 therapy subjects did not experience paresthesias. Conclusion: HF10 therapy promises to substantially impact the management of back and leg pain with broad applicability to patients, physicians, and payers.

Download Full-text

Age as an Independent Predictor of Adult Spinal Cord Stimulation Pain Outcomes

Stereotactic and Functional Neurosurgery ◽

10.1159/000517426 ◽

2021 ◽

pp. 1-7

Author(s):

Melanie Bondoc ◽

Maria Hancu ◽

Marisa DiMarzio ◽

Breanna L. Sheldon ◽

Miriam M. Shao ◽

...

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Regression Analysis ◽

Spinal Cord Stimulation ◽

Rating Scale ◽

Pain Treatment ◽

Pain Catastrophizing ◽

Expected Improvement ◽

Mcgill Pain Questionnaire ◽

Significant Difference

Introduction: Spinal cord stimulation (SCS) is an efficacious chronic pain treatment most commonly used in middle-aged patients. Results from previous studies that investigated SCS′ effects in older patient populations have been equivocal. We examine whether SCS outcomes correlate with age. Methods: We retrospectively examined prospectively collected outcomes from 189 patients who underwent SCS at Albany Medical Center between 2012 and 2020. The patients completed the Numerical Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) preoperatively and 1 year postoperatively. The mean percent change in each outcome was determined and compared via a regression analysis to determine relationships between patient age and each respective outcome metrics. Demographics were compared between patients aged under 65 versus those aged 65 and older via χ2 tests. Results: All subjects demonstrated the expected improvement on NRS, BDI, PCS, and MPQ from baseline to 1-year follow-up, with several demonstrating statistically significant changes: NRS-worst pain (18.66%, p < 0.001), NRS-least pain (26.9%, p < 0.001), NRS-average pain (26.9%, p < 0.01), NRS-current pain (26.4%, p < 0.001), ODI (19.6%, p < 0.001), PCS (29.8%, p < 0.001), and MPQ (29.4%, p < 0.001). There was no significant difference between patients aged under 65 versus those aged 65 and older based on lead type (p = 0.454). Six patients (3.1%) had lead migration, one of whom was 65 or older. Regression analysis revealed improvements in MPQ-sensory and MPQ-affective scores as age increased (p < 0.001, R2 = 0.09; p = 0.046, R2 = 0.05, respectively). Age did not correlate with NRS, ODI, BDI, or PCS. Diagnosis, spinal level of SCS, and lead type were not found to influence any respective outcome measure based on covariate analysis. Conclusion: This study represents the largest study where age was correlated to specific pain, depression, and disability outcomes following SCS. We provide evidence that SCS outcomes are equivalent, or better, in older patients following SCS. Based on these findings, SCS is a viable option for treatment of chronic pain in elderly patient populations.

Download Full-text

Efficacy and Safety of Spinal Cord Stimulation in Patients With Chronic Intractable Pain

Case Medical Research ◽

10.31525/ct1-nct03858790 ◽

2019 ◽

Author(s):

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Intractable Pain ◽

Efficacy And Safety

Download Full-text

1-kHz high-frequency spinal cord stimulation alleviates chronic refractory pain after spinal cord injury: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00451-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Chiaki Yamada ◽

Aiko Maeda ◽

Katsuyuki Matsushita ◽

Shoko Nakayama ◽

Kazuhiro Shirozu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Cervical Vertebrae ◽

Intractable Pain ◽

Target Area ◽

Positive Effects ◽

Cord Injury

Abstract Background Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. Case presentation A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. Conclusions SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.

Download Full-text

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.

Download Full-text

Brain fMRI during orientation selective epidural spinal cord stimulation

Scientific Reports ◽

10.1038/s41598-021-84873-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Antonietta Canna ◽

Lauri J. Lehto ◽

Lin Wu ◽

Sheng Sang ◽

Hanne Laakso ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pain Treatment ◽

Positive Impact ◽

Sensory Information ◽

Activation Patterns ◽

Promising Tool ◽

Cord Injury ◽

Epidural Spinal Cord Stimulation ◽

Brain Fmri

AbstractEpidural spinal cord stimulation (ESCS) is widely used for chronic pain treatment, and is also a promising tool for restoring motor function after spinal cord injury. Despite significant positive impact of ESCS, currently available protocols provide limited specificity and efficiency partially due to the limited number of contacts of the leads and to the limited flexibility to vary the spatial distribution of the stimulation field in respect to the spinal cord. Recently, we introduced Orientation Selective (OS) stimulation strategies for deep brain stimulation, and demonstrated their selectivity in rats using functional MRI (fMRI). The method achieves orientation selectivity by controlling the main direction of the electric field gradients using individually driven channels. Here, we introduced a similar OS approach for ESCS, and demonstrated orientation dependent brain activations as detected by brain fMRI. The fMRI activation patterns during spinal cord stimulation demonstrated the complexity of brain networks stimulated by OS-ESCS paradigms, involving brain areas responsible for the transmission of the motor and sensory information. The OS approach may allow targeting ESCS to spinal fibers of different orientations, ultimately making stimulation less dependent on the precision of the electrode implantation.

Download Full-text

Spinal Cord Stimulation for Chronic Intractable Pain: Nursing Implications

Journal of Neuroscience Nursing ◽

10.1097/01376517-199412000-00007 ◽

1994 ◽

Vol 26 (6) ◽

pp. 347-351 ◽

Cited By ~ 2

Author(s):

Michele Gilbert ◽

Colleen M. Counsell ◽

Pam Martin ◽

Christie Snively

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Intractable Pain

Download Full-text