High-frequency Spinal Cord Stimulation as a Palliative Treatment for Patients with Low Back and Lower Extremity Radiated Chronic Pain

BACKGROUND: High-frequency spinal cord stimulation (HF-SCS) has become very popular in the management of chronic pain worldwide. As it relies on generating high-frequency electrical impulses, there is a risk of interference with other devices such as cochlear implants that utilize similar principles. A literature search did not reveal any case reports of HF-SCS implantation in a patient with cochlear implants. CASE REPORT: A 75-year-old White woman with a history of bilateral cochlear implants (Cochlear Americas Nucleus® with cp910 processor) for severe sensorineural hearing loss presented to our chronic pain clinic with lumbosacral radiculopathy. The patient underwent a HF-SCS trial with entry point at the L1-L2 space and the leads positioned at the top and bottom of T8. The patient did not experience any auditory interference with her Cochlear implant at triple the average SCS stimulation strength. During the follow-up visit the next week, the patient reported nearly 80% symptomatic pain relief and significant functional improvement. There was no change in her hearing and no evidence of interference. The patient ultimately underwent percutaneous SCS paddle electrode placement and at 3 months, continues to have excellent pain relief without any auditory interactions. CONCLUSION: We successfully implanted a HF-SCS at the thoracic level in a patient with bilateral cochlear implants without any auditory interference. KEY WORDS: Cochlear implant, lumbar radiculopathy, spinal cord stimulation

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Long-Term Improvements in Chronic Axial Low Back Pain Patients Without Previous Spinal Surgery: A Cohort Analysis of 10-kHz High-Frequency Spinal Cord Stimulation over 36 Months

Pain Medicine ◽

10.1093/pm/pnx237 ◽

2017 ◽

Vol 19 (6) ◽

pp. 1219-1226 ◽

Cited By ~ 26

Author(s):

Adnan Al-Kaisy ◽

Stefano Palmisani ◽

Thomas E Smith ◽

Roy Carganillo ◽

Russell Houghton ◽

...

Keyword(s):

Spinal Cord ◽

Low Back Pain ◽

Back Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Spinal Surgery ◽

Cohort Analysis ◽

Low Back ◽

Pain Patients

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High-frequency spinal cord stimulation: An emerging treatment option for patients with chronic pain

Techniques in Regional Anesthesia and Pain Management ◽

10.1053/j.trap.2012.12.002 ◽

2012 ◽

Vol 16 (2) ◽

pp. 106-112 ◽

Cited By ~ 2

Author(s):

Ricardo Vallejo

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Treatment Option ◽

Spinal Cord Stimulation ◽

High Frequency

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Multicentre, Double Blind, Randomised Sham-Controlled Trial of 10kHz High-Frequency Spinal Cord Stimulation for Chronic Neuropathic Low Back Pain (MODULATE-LBP): A Trial Protocol

10.21203/rs.2.12200/v1 ◽

2019 ◽

Author(s):

Adnan Al-Kaisy ◽

Jonathan Royds ◽

Stefano Palmisani ◽

David Pang ◽

Samuel Wesley ◽

...

Keyword(s):

Spinal Cord ◽

Low Back Pain ◽

Back Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Controlled Trial ◽

Low Back ◽

Double Blind ◽

Prior Surgery ◽

Secondary Outcomes

Abstract Introduction Chronic neuropathic low back pain (CNLBP) is a debilitating condition in which established medical treatments seldom alleviate symptoms. There is evidence demonstrating high frequency 10kHz spinal cord stimulation (SCS) reduces pain and improves health-related quality of life in patients with Failed Back Surgery Syndrome (FBSS) but there is limited evidence in CNLBP without prior surgery. The aim of this multicentre randomised trial is to assess the clinical and cost-effectiveness of 10kHz SCS for this population. Methods This is a multicentre double-blind randomised sham-controlled trial with a parallel economic evaluation. A total of 96 patients with CNLBP who have not had spinal surgery will be implanted with an epidural lead and a sham lead outside the epidural space without a screening trial. Patients will be randomised 1:1 to 10kHz SCS plus usual care (intervention group) or sham 10kHz SCS plus usual care (control group) after full implant. The SCS devices will be programmed identically using a cathodal cascade. Participants will use their handheld programmer to alter the intensity of the stimulation as per routine practice. Primary outcome will be a 7 day daily pain diary. Secondary outcomes include the Oswestry Disability Index, complications, EQ-5D-5L, and health and social care costs. Outcomes will be assessed at baseline (pre-randomisation) and at 1 month, 3 months and 6 months after device activation. The primary analyses will compare primary and secondary outcomes between groups at 6-months adjusting for baseline outcome scores. Incremental cost per quality adjusted life year (QALY) will be calculated at 6-months and over the patient lifetime. Discussion The outcomes of this trial will inform clinical practice and healthcare policy on the role of high frequency 10kHz SCS for patients with CNLBP without prior surgery.

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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 ◽

10.1093/pm/pnz019 ◽

2019 ◽

Vol 20 (10) ◽

pp. 1971-1979 ◽

Cited By ~ 3

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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