The use of spinal cord stimulation in pain management (original) (raw)
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Spinal Cord Stimulation for Chronic Pain
Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS.
Neuromodulation: Technology at the Neural Interface, 2007
A prospective, open label, multicenter clinical trial confirmed the functionality of a new spinal cord stimulation (SCS) system for the treatment of chronic, intractable pain of the trunk and/or limbs. Materials and Methods. Sixty-five subjects tested a rechargeable 16-channel SCS system with individual current control of each contact on one or two percutaneous eight-contact epidural leads. After baseline measurements, subjects were tracked on pain ratings and complication rates for up to 18 months. Results. After a trial period, 75% of subjects underwent permanent implantation of the entire SCS system. More than one-half the implanted subjects experienced 50% or greater relief of pain after permanent implantation; some subjects reported relief of 90% or more of their pain. The most common complications after permanent implantation were lead migration, uncomfortable stimulation, and component failure; most resolved after reprogramming or device replacement. Conclusions. The new SCS system provided good pain relief to a majority of subjects, and the results confirm a favorable safety and efficacy profile for the SCS system.
Spinal cord stimulation for the management of pain: Recommendations for best clinical practice
South African Medical Journal, 2013
Spinal cord stimulation (SCS) is a form of therapy with a supportive evidence base, and has been used for the treatment of pain since 1967. It is strategically aimed at reducing the unpleasant sensory experience of pain and the consequent functional and behavioural effects that pain may have. When SCS is used to treat patients with chronic pain, it is important that the treatment is delivered within the context of a full understanding of the impact that pain has upon the patient, including its effect on quality of life. Pain can and does affect patients' psychological well-being and social functions. These recommendations give guidance to practitioners delivering this treatment, to those who may wish to refer patients for SCS, and to those who care for patients with stimulators in situ. The recommendations also provide a resource for organisations that fund SCS. Spinal cord stimulation for the management of pain: Recommendations for best clinical practice A consensus document prepared on behalf of Pain SA in consultation with the South African Spine Society, the Neurological Society of South Africa, and the South African Society of Anaesthesiologists, with guidance from the British Pain Society. These recommendations have been produced by a consensus group (below) of relevant healthcare professionals, and refer to the current body of evidence relating to spinal cord stimulation (SCS).
Spinal Cord Stimulation for Treating Chronic Pain
Spine, 2018
Background: Traditional spinal cord stimulation (SCS) requires that paresthesia overlaps chronic painful areas. However, the new paradigm high-frequency SCS (HF-SCS) does not rely on paresthesia. Study Design: A review of preclinical and clinical studies regarding the use of paresthesia-free HF-SCS for various chronic pain states. Methods: We reviewed available literatures on HF-SCS, including Nevro's paresthesia-free ultra high-frequency 10 kHz therapy (HF10-SCS). Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, and SCOPUS, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary goal is to describe the present developing conceptions of preclinical mechanisms of HF-SCS and to review clinical efficacy on paresthesia-free HF10-SCS for various chronic pain states. Results: HF10-SCS offers a novel pain reduction tool without paresthesia for failed back surgery syndrome and chronic axial back pain. Preclinical findings indicate that potential mechanisms of action for paresthesia-free HF-SCS differ from those of traditional SCS. Conclusions: To fully understand and utilize paresthesia-free HF-SCS, mechanistic study and translational research will be very important, with increasing collaboration between basic science and clinical communities to design better trials and optimize the therapy based on mechanistic findings from effective preclinical models and approaches. Future research in these vital areas may include preclinical and clinical components conducted in parallel to optimize the potential of this technology.
Spinal Cord Stimulation Has Comparable Efficacy in Common Pain Etiologies
Neuromodulation: Technology at the Neural Interface, 2008
Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods. Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. Subjects reported pain ratings (visual analog scale) with stimulation off and stimulation on at scheduled follow-up visits for up to 18 months after activation of the system. Visual analog scale scores were averaged and stratified by dominant pain etiologies, comprising failed back surgery syndrome, complex regional pain syndrome, and a subgroup of subjects with miscellaneous other pain etiologies. Results. More than 70% of subjects in each subgroup had successful outcomes during the temporary trial period and similar percentages of subjects from each etiology subgroup subsequently went on to permanent implantation. After permanent implantation, all subgroups reported more than 50% pain relief, on average, at each follow-up time point. No predictive value of pain etiology was obser ved. Conclusions. Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surger y syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.
Efficacy and Importance of Spinal Cord Stimulation for Pain
2021
Since its discovery, Spinal Cord Stimulation (SCS) has been widely used. Spinal cord stimulation has been currently established as an efficient therapy for treatment of resistant pain syndromes. SCS system technologically improved from its conventional way to novel stimulation paradigms which have been considerable and the current Neuromodulation therapies which are evolving are extremely sophisticated and reliable in obtaining good results. SCS therapy is well established now for different clinical conditions of chronic pain, such as failed back syndrome (FBSS), complex regional pain syndrome (CRPS), peripheral nerve injuries pain etc.
Mechanisms , Actions and New Paradigms : Spinal Cord Stimulation for Pain Management
2021
Ever since the discovery of Spinal cord stimulation (SCS) in the late 1960s, it has been widely used as a treatment option for chronic neuropathic pain management. SCS has succeeded clinically in a subset of managing chronic neuropathic pain syndromic conditions. It has several limitations as well such as insufficient pain relief or control, uncomfortable sensation called paresthesia etc. These limitations pushed the conventional methods to the need of developing new targets or paradigms for Spinal Cord Stimulation like the dorsal root ganglion stimulation, burst waveform stimulation and high frequency Spinal cord Stimulation. The aim of this review is to provide a brief and concrete detail on the mechanisms and actions of SCS.
Spinal cord stimulation in chronic pain: technical advances
The Korean Journal of Pain, 2020
Chronic severe pain results in a detrimental effect on the patient's quality of life. Such patients have to take a large number of medications, including opioids, often without satisfactory effect, sometimes leading to medication abuse and the pain worsening. Spinal cord stimulation (SCS) is one of the most effective technologies that, unlike other interventional pain treatment methods, achieves long-term results in patients suffering from chronic neuropathic pain. The first described mode of SCS was a conventional tonic stimulation, but now the novel modalities (high-frequency and burst), techniques (dorsal root ganglia stimulations), and technical development (wireless and implantable pulse generator-free systems) of SCS are becoming more popular. The improvement of SCS systems, their miniaturization, and the appearance of new mechanisms for anchoring electrodes results in a significant reduction in the rate of complications and revision surgeries, and the appearance of new waves of stimulation allows not only to avoid the phenomenon of addiction, but also to improve the long-term results of chronic SCS. The purpose of this review is to describe the current condition of SCS and up-to-date technical advances.
Current Challenges in Spinal Cord Stimulation
Neuromodulation: Technology at the Neural Interface, 2014
Objectives: This study aims to review the current state of spinal cord stimulation for the treatment of chronic pain associated with failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS) and to describe intraspinal targets and stimulation parameters, patient selection, therapy cost-effectiveness, and strategies to improve outcomes.
Spinal Cord Stimulation: The Use of Neuromodulation for Treatment of Chronic Pain
2020
INTRODUCTION Chronic Pain and the Role of Neuromodulation Chronic pain, defined as pain persistent for more than 3–6 months, affects 100 million adults in the United States (US) and impacts all dimensions of health-related quality of life (QOL) and healthcare expenditures.1 Low back pain is the leading cause of disability, with healthcare expenditures estimated to be as much as 560–560–560–635 billion, more than the combined spending on heart disease and diabetes.1 Despite lack of consistent evidence, rates of spine surgeries have increased, while other forms of chronic pain management, including narcotics, contribute to both adverse medical side effects and the ongoing opioid epidemic.2 As such, additional treatment options for chronic pain are being studied. One promising option is spinal cord stimulation (SCS), a form of neuromodulation used since the 1960s. Recently, a paradigm shift has occurred, with SCS increasingly accepted as a first-line therapy after noninvasive treatment (phys...