Spinal Cord Stimulation Research Papers (original) (raw)

Spinal cord stimulation (SCS) is an effective method of relieving chronic intractable pain, and one of its key indications is failed back surgery syndrome (FBSS). The objective of the current study was to evaluate the cost effectiveness of 10 kHz high-frequency SCS (HF10 SCS) compared to conventional medical management (CMM), reoperation, and traditional nonrechargeable (TNR-SCS) and rechargeable SCS (TR-SCS). A health economic model of SCS in the United Kingdom was reproduced in the perspective of the health care system to simulate costs and quality adjusted life years (QALYs) over 15 years. In the model, both a decision tree and the Markov model were used to describe the health outcomes of the evaluated therapies. HF10 SCS therapy showed a favorable incremental cost-effectiveness ratio (ICER) of £3,153 per QALY gained as compared to CMM and established dominance (less costly, more QALYs) compared to TNR-SCS (£8,802 per QALY vs. CMM) and TR-SCS (£5,101 per QALY vs. CMM). This first...

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- Treatment Outcome, Decision Trees, Humans, Electromagnetic Radiation
- by Andre Wolff
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- Pain, Evidence Based Medicine, Pain Management, Brain and Cognition
- by peter staats
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- Cognitive Science, Neuromodulation, Clinical Sciences, Spinal Cord Stimulation

The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medi...

- by Syed Hadi Abbas Rizvi
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- Cognitive Science, Neuromodulation, Chronic Pain, Pain Management
- by Gustavo Fabregat and +2
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- Pain, Wound Healing, Treatment Outcome, Biopsy
- by Giuseppe Talamonti
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- Biomedical Engineering, Humans, Spinal Cord, Hemiplegia
- by Marlís González-fernández
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- Pain, Chronic Pain, Treatment Outcome, Pain Management
- by Mario Meglio and +1
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- Cognitive Science, Neuromodulation, Clinical Sciences, Spinal Cord Stimulation
- by Ewout Steyerberg
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- Pain, Clinical Trial, Quality of life, Humans
- by Rahul Nath
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- Pain, Chronic Pain, Treatment, Humans
- by N. Buisset
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- Neuropathic pain, Spinal Cord Stimulation
- by Joshua Prager
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- Cognitive Science, Neuromodulation, Clinical Sciences, Spinal Cord Stimulation

- by Paul Verrills and +1
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- Cognitive Science, Neuromodulation, Chronic Pain, Pain Management
- by Mario Meglio
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- Psychological Assessment, Pain, Chronic Pain, Spinal Cord Stimulation

This chapter surveys the different control methods developed for spinal cord stimulation to restore walking after neural injury or disease. We start by exploring the networks within the spinal cord that control or modulate walking. Next we introduce the different modes of stimulating the spinal cord: intraspinal microstimulation, epidural spinal cord stimulation, and magnetic spinal cord stimulation. Finally, we delve into the control strategies developed for these spinal cord stimulation methods to generate walking. Many of the control methods were inspired by the locomotor central pattern generator. Others took a more traditional control engineering approach by implementing non-linear control methods such fuzzy logic and sliding mode control. The ultimate goal is to achieve effortless and natural walking that is adaptable and personalized to the user. Although this goal is a few years away from being realized, the integration of engineering, neuroscience, and rehabilitation is certainly the right approach.

- by Andre Wolff
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- Pain, Evidence Based Medicine, Pain Management, Brain and Cognition
- by Roberto Grimaldi
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- Biomedical Engineering, Neuromodulation, Quality of life, Treatment Outcome
- by Kerry Bradley and +1
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- Cognitive Science, Neuromodulation, Chronic Pain, Electrical Impedance Tomography

Objective: The physiological mechanisms behind the therapeutic effects of spinal cord stimulation (SCS) are only partially understood. Our aim was to perform a literature review of studies that used objective measures to characterize mechanisms of action of SCS in neuropathic pain patients. Materials and Methods: We searched the PubMed data base to identify clinical studies that used objective measures to assess the effects of SCS in neuropathic pain. We extracted the study factors (e.g., type of measure, diagnoses, painful area[s], and SCS parameters) and outcomes from the included studies. Results: We included 67 studies. Of these, 24 studies used neurophysiological measures, 14 studies used functional neuroim-aging techniques, three studies used a combination of neurophysiological and functional neuroimaging techniques, 14 studies used quantitative sensory testing, and 12 studies used proteomic, vascular, and/or pedometric measures. Our findings suggest that SCS largely inhibits somatosensory processing and/or spinal nociceptive activity. Our findings also suggest that SCS modulates activity across specific regions of the central nervous system that play a prominent role in the sensory and emotional functions of pain. Conclusions: SCS appears to modulate pain via spinal and/or supraspinal mechanisms of action (e.g., pain gating, descending pain inhibition). However, to better understand the mechanisms of action of SCS, we believe that it is necessary to carry out systematic, controlled, and well-powered studies using objective patient measures. To optimize the clinical effectiveness of SCS for neuropathic pain, we also believe that it is necessary to develop and implement patient-specific approaches.

- by V. Sankarasubramanian and +1
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- Chronic Pain, Clinical Sciences, Spinal Cord Stimulation, Neurophysiology of Neurostimulation
- by Cédric Lemogne
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- Psychology, Chronic Pain, Pain Management, Post traumatic stress disorder
- by Dayna Finkenzeller
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- Evidence Based Medicine, Chronic Pain, Humans, Chronic Disease

Neuromodulation is an effective and reversible treatment option for chronic intractable pain. Spinal cord stimulation (SCS) represents a field of application of neuromodulation and is known to be effective for several conditions including complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS), and chronic leg and back pain. SCS has some technical limitations that can be bypassed through retrograde neuromodulation. To examine the safety and efficacy of retrograde neuromodulation in consecutive patients with neuropathic pain in the perineum or lower limb. Prospective chart review analyzing one year of retrograde stimulation in our department. We present a series of 10 patients who underwent retrograde neuromodulation at the University General Hospital of Valencia (Spain). We analyzed the variables that can improve the outcome and help physicians choose retrograde neuromodulation. Seven of 10 patients had an effective treatment and 3 patients had an ineffective stim...

- by Luciano Perotti and +1
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- Treatment Outcome, Humans, Female, Male
- by N. Buisset and +1
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- Neuropathic pain, Spinal Cord Stimulation
- by Francesco Brigo
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- Cognitive Science, Neuromodulation, Humans, Bibliographic Databases
- by Csilla Molnár
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- Skeletal muscle biology, Dogs, Animals, Spinal Cord
- by Nagy Mekhail and +5
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- Cognitive Science, Neurosurgery, Neuromodulation, Evidence Based Medicine
- by Nicolas Reyns
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- Deep Brain Stimulation, Chronic Pain, Pain Management, Humans

An ability to produce rhythmic activity is ubiquitous for locomotor pattern generation and modulation. The role that the rhythmogenesis capacity of the spinal cord plays in injured populations has become an area of interest and systematic investigation among researchers in recent years, despite its importance being long recognized by neurophysiologists and clinicians. Given that each individual interneuron, as a rule, receives a broad convergence of various supraspinal and sensory inputs and may contribute to a vast repertoire of motor actions, the importance of assessing the functional state of the spinal locomotor circuits becomes increasingly evident. Air-stepping can be used as a unique and important model for investigating human rhythmogenesis since its manifestation is largely facilitated by a reduction of external resistance. This article aims to provide a review on current issues related to the " locomotor " state and interactions between spinal and supraspinal influences on the central pattern generator (CPG) circuitry in humans, which may be important for developing gait rehabilitation strategies in individuals with spinal cord and brain injuries.

- by Y. Ivanenko
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- Spinal Cord Injury, Spinal Cord, Sensory Integration, Central Pattern Generators
- by Kris Vissers
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- Chronic Pain, Spinal Cord Stimulation, Radiofrequency

• Air-stepping can be used as a model for investigating rhythmogenesis/CPG in humans. • We compared voluntary and non-voluntary (vibration-induced) stepping. • We examined MEPs in response to TMS of the motor cortex and H-reflex. • We found greater responsiveness to central/sensory inputs during voluntary stepping. • Findings support engagement of supraspinal motor areas in CPG-modulating therapies. a b s t r a c t Here, we compared motor evoked potentials (MEP) in response to transcranial magnetic stimulation of the motor cortex and the H-reflex during voluntary and vibration-induced air-stepping movements in humans. Both the MEPs (in mm biceps femoris, rectus femoris and tibialis anterior) and H-reflex (in m soleus) were significantly smaller during vibration-induced cyclic leg movements at matched amplitudes of angular motion and muscle activity. These findings highlight differences between voluntary and non-voluntary activation of the spinal pattern generator circuitry in humans, presumably due to an extra facilitatory effect of voluntary control/triggering of stepping on spinal motoneurons and interneurons. The results support the idea of active engagement of supraspinal motor areas in developing central pattern generator-modulating therapies.

- by Y. Ivanenko
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- TMS, Spinal Cord, Central Pattern Generators, Spinal Cord Stimulation
- by N. Buisset and +1
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- Deep Brain Stimulation, Chronic Pain, Pain Management, Humans
- by Jason Pope
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- Cognitive Science, Algorithms, Neuromodulation, Humans
- by Yung-Hsiang Chen
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- Surgery, Neuromodulation, Treatment, Treatment Outcome
- by Elbert Joosten
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- Humans, Animals, Spinal Cord, Spinal Cord Stimulation

Complex regional pain syndrome is a condition that usually affects the upper or lower extremities. The cause is not clearly understood. We report a case of a severe form of a rapidly progressive complex regional pain syndrome type I developing after a right shoulder injury managed with spinal cord stimulation (SCS). After failed conservative treatments, a rechargeable SCS system was implanted in the cervical spine. Allodynia and dystonia improved but the patient subsequently developed similar symptoms in lower right extremity followed by her lower left extremity. The patient became wheelchair bound. A second rechargeable SCS with a paddle electrode was implanted for the lower extremity coverage. The patient's allodynia and skin lesions improved significantly. However, over time, her initial symptoms reappeared which included skin breakdown. Due to the need for frequent recharging, the system was removed. During explantation of the surgical paddle lead, it was noted by the neurosurgeon that the contacts of the paddle lead were detached from the lead. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch.

- by Eric Gabriel
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- Humans, Female, Spinal Cord, Young Adult
- by Guido Rodriguez
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- Adolescent, Brain Mapping, Humans, Hemodynamics

Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain in the lower limbs. Upper limb pain comprises a significant proportion of neuropathic pain patients, but is often difficult to target specifically and consistently with paresthesias. We hypothesized that the use of dorsal nerve root stimulation (DNRS), as an option along with SCS, would help us better relieve pain in these patients. Methods: All 35 patients trialed with spinal stimulation for upper limb pain between July 1, 2011, and October 31, 2013, were included. We performed permanent implantation in 23/35 patients based on a visual analogue scale pain score decrease of ≥50% during trial stimulation. Results: Both the SCS and DNRS groups had significant improvements in average visual analogue scale pain scores at 12 months compared with baseline, and the majority of patients in both groups obtained ≥50% pain relief. The majority of patients in both groups were able to reduce th...

- by Andrew Parrent
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- Cognitive Science, Treatment Outcome, Adolescent, Humans

Refractory angina is characterized by repeated attacks of chest pain in patients on maximal anti-anginal pharmacotherapy, with a professional conscensus that further surgical or radiological revascularization would be futile. Refractory angina is a serious but relatively uncommon health problem, with a reported incidence of approximately 30 patients per million people/year. In this condition simply treating the associated pain alone is important as this can improve exercise tolerance and quality of life. An extensive literature search using five different medical databases was performed and from this, eighty-three papers were considered appropriate to include within this review. Available literature highlights several methods of interventional pain treatment, including spinal cord stimulation and video-assisted upper thoracic sympathectomy which can provide good analgesia whilst improving physical activities and quality of life. The positive effect of spinal cord stimulation on the ...

- by Paul Johnston
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- Quality of life, Pain Management, Humans, Spinal Cord Stimulation
- by Richard Deyo
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- Pain, Chronic Pain, Treatment Outcome, Physical Therapy

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. 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. At 3 months, 84.5% of implanted HF10 therapy subjects were responders for back pain and 83.1% for leg...

- by Ricardo Vallejo and +6
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- Anesthesiology, Chronic Pain, Treatment Outcome, Pain Management

- by Jason Pope and +3
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- Cognitive Science, Neuromodulation, Chronic Pain, Pain Management
- by Krishna Kumar
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- Neurosurgery, Pain, Depression, Treatment Outcome

The purpose of the international multicenter prospective single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain (CMLBP) in patients who have failed conventional therapy and are not candidates for surgery or spinal cord stimulation (SCS). Fifty-three subjects were implanted with a neurostimulator (ReActiv8, Mainstay Medical Limited, Dublin, Ireland). Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve. The primary outcome measure was low back pain evaluated on a 10-Point Numerical Rating Scale (NRS). Responders were defined as subjects with an improvement of at least the Minimal Clinically Important Difference (MCID) of ≥2-point in low back pain NRS without a clinically meaningful increase in LBP medications at 90 days. Secondary outcome measures included Oswestry Disability Index (ODI) and Quality of Life (QoL...

- by Marc Russo
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- Cognitive Science, Neuromodulation, Chronic Pain, Quality of life
- by Jutta Ellermann
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- Pain, Magnetic Resonance Imaging, Brain, Humans
- by SANJAY SASTRY
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- Pain Management, Paraplegia, Spinal Cord Stimulation
- by Bijan Najafi
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- Mechanical Engineering, Signal Processing, Pain, Chronic Pain
- by Andre Wolff
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- Pain, Evidence Based Medicine, Pain Management, Brain and Cognition
- by peter staats
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- Algorithms, Pain, Evidence Based Medicine, Quality of life
- by Eric Verhulst
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- Surgery, Modeling, Treatment, Comparative Study