Increased Pain Catastrophizing Associated With Lower Pain Relief During Spinal Cord Stimulation: Results From a Large Post-Market Study

2015 ◽  
Vol 18 (4) ◽  
pp. 277-284 ◽  
Author(s):  
Jason C. Rosenberg ◽  
David M. Schultz ◽  
Luis E. Duarte ◽  
Steven M. Rosen ◽  
Adil Raza
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Pain Catastrophizing ◽  
Post Market ◽  
Lower Pain

Spinal Cord Stimulation: A Contemporary Series

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Roberto Spiegelmann ◽  
William A. Friedman
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Literature Review ◽  
General Anesthesia ◽  
Detailed Analysis ◽  
Spinal Cord Stimulation ◽  
Significant Pain ◽  
Experience Pain

Abstract Forty-three patients with chronic pain disorders of different causes were selected for spinal cord stimulation. All underwent implantation of a ribbon electrode through a small laminotomy, under general anesthesia. Thirteen patients (30%) failed to obtain significant pain relief during a period of trial stimulation, and their electrodes were removed. The remainder underwent a definitive implant and were followed for a mean of 13 months (range, 3-33 months). Nineteen of them (63%) continued to experience pain relief. A detailed analysis of this series, as well as a literature review, is presented.

scholarly journals Pain Relief and Safety Outcomes with Cervical 10 kHz Spinal Cord Stimulation: Systematic Literature Review and Meta-analysis

2021 ◽  
Author(s):  
Ganesan Baranidharan ◽  
Beatrice Bretherton ◽  
Craig Montgomery ◽  
John Titterington ◽  
Tracey Crowther ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Spinal Cord Stimulation ◽  
Meta Analysis ◽  
Safety Outcomes

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 Pain relief and quality-of-life improvement after spinal cord stimulation in painful diabetic polyneuropathy: a pilot study

2012 ◽  
Vol 109 (5) ◽  
pp. 837 ◽  
Author(s):  
W.A. Pluijms ◽  
R Slangen ◽  
M Bakkers ◽  
C.G. Faber ◽  
I.S.J. Merkies ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Pilot Study ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Diabetic Polyneuropathy ◽  
Life Improvement

scholarly journals High Frequency Spinal Cord Stimulation in a Patient with Bilateral Cochlear Implants

2021 ◽  
pp. 189-191
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Pain Clinic ◽  
Bilateral Cochlear Implants ◽  
Patient Reported

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

Spinal Cord Stimulation in Treatment of Chronic Benign Pain: Challenges in Treatment Planning and Present Status, a 22-Year Experience

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. 481-496 ◽  
Author(s):  
Krishna Kumar ◽  
Gary Hunter ◽  
Denny Demeria
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Pain Clinic ◽  
Axial Component

Abstract OBJECTIVE: To present an in-depth analysis of clinical predictors of outcome including age, sex, etiology of pain, type of electrodes used, duration of pain, duration of treatment, development of tolerance, employment status, activities of daily living, psychological status, and quality of life. Suggestions for treatment of low back pain with a predominant axial component are addressed. We analyzed the complications and proposed remedial measures to improve the effectiveness of this modality. METHODS: Study group consists of 410 patients (252 men, 58 women) with a mean age of 54 years and a mean follow-up period of 97.6 months. All patients were gated through a multidisciplinary pain clinic. The study was conducted over 22 years. RESULTS: The early success rate was 80% (328 patients), whereas the long-term success rate of internalized patients was 74.1% (243 patients) after the mean follow-up period of 97.6 months. Hardware-related complications included displaced or fractured electrodes, infection, and hardware malfunction. Etiologies demonstrating efficacy included failed back syndrome, peripheral vascular disease, angina pain, complex regional pain syndrome I and II, peripheral neuropathy, lower limb pain caused by multiple sclerosis. Age, sex, laterality of pain or number of surgeries before implant did not play a role in predicting outcome. The percentage of pain relief was inversely related to the time interval between pain onset and time of implantation. Radicular pain with axial component responded better to dual Pisces electrode or Specify-Lead implantation. CONCLUSION: Spinal cord stimulation can provide significant long-term pain relief with improved quality of life and employment. Results of this study will be effective in better defining prognostic factors and reducing complications leading to higher success rates with spinal cord stimulation.

Choice of spinal cord stimulation versus targeted drug delivery in the management of chronic pain: a predictive formula for outcomes

2020 ◽  
pp. rapm-2019-100859
Author(s):  
Nagy Mekhail ◽  
Diana S Mehanny ◽  
Sherif Armanyous ◽  
Shrif Costandi ◽  
Youssef Saweris ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Spinal Cord ◽  
Pain Relief ◽  
Targeted Drug Delivery ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Cleveland Clinic ◽  
Cost Effective ◽  
Implantable Devices ◽  
Targeted Drug

Contemporary nonmalignant pain treatment algorithms commence with conservative non-invasive strategies, later progressing from minimally invasive interventions to invasive techniques or implantable devices. The most commonly used implantable devices are spinal cord stimulation (SCS) systems or targeted drug delivery (TDD) devices. Historically, SCS had been considered in advance of TDD, positioning TDD behind SCS failures. Following Institutional Review Board approval, data were extracted from electronic medical records of patients who underwent SCS trial in the Department of Pain Management at Cleveland Clinic from 1994 to 2013. The sample size was analyzed in two cohorts: those who succeeded with SCS and those who failed SCS and consequently proceeded to TDD. Univariate and multivariate analyses were performed and a predictive formula for successful outcomes was created. 945 patients were included in the cohort of which 119 (12.6%) subjects achieved adequate pain relief with TDD after failure of SCS. Gender, age, depression and primary pain diagnosis were significantly different in this subgroup. Males were 52% less likely to experience pain relief with SCS. The odds of SCS success decreased as age increased by 6% per year. Patients with comorbid depression, interestingly, were 63% more likely to succeed with SCS. A logistic model was created to predict SCS success which was used to create a predictive formula. Older male patients diagnosed with spine-related pain were more likely to benefit from TDD than SCS. This observation potentially identifies a subgroup in whom consideration for TDD in advance of SCS failure could prove more efficient and cost effective. These retrospective findings warrant prospective comparative studies to validate this derived predictive formula.

scholarly journals Spinal Cord Stimulation With Nonlinear Burst Stimulation Design Improves Psychosocial Function Through the Medial Spinothalamic Tract

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Steven M Falowski
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Physical Function ◽  
Spinal Cord Stimulation ◽  
Pain Catastrophizing ◽  
Psychosocial Outcomes ◽  
Burst Stimulation ◽  
Spinothalamic Tract ◽  
Population Norm

Abstract INTRODUCTION Tonic spinal cord stimulation (SCS) mainly modulates the lateral spinothalamic tract relaying information for quality and intensity of pain. In contrast, nonlinear burst stimulation affects the lateral, medial, and descending pain pathways. The medial spinothalamic tract has been associated with emotional and motivational aspects of pain, such as pain catastrophizing and suffering. The objective of this prospective, multi-center, single arm trial was to assess functional and psychosocial outcomes after SCS using a burst stimulation design. METHODS Eligible patients with chronic, intractable pain of the trunk and/or lower limbs were enrolled. After a successful trial period, patients received a permanent SCS implant and returned for follow-up at 6 mo. Quality of life (EQ-5D), mental health (PCS, PHQ-9), and physical function (TSK, PROMIS-8) were recorded. RESULTS 173 patients at 21 centers received a permanent implant. We observed an improvement in all functional and psychosocial outcomes compared to baseline (P < .0001). About 74% of patients achieved a result that was equal to (within 10%) or better than the population norm for at least one outcome measure. Specifically, overall quality of life (EQ-5D) improved from 0.4 to 0.7. Mean pain catastrophizing (PCS) score dropped below the population norm (14); 70% of patients who were clinically catastrophizing (score of ≥30) at baseline, were not at 6 mo. Patients who were moderately or severely depressed at baseline (n = 82) showed a clinically significant improvement to mild depression. Patients displayed an improved physical function and reduced kinesiophobia (TSK). Furthermore, 75% of patients were satisfied or very satisfied with their therapy. Finally, 68% (84/123) reduced their opioid usage at 6 mo. CONCLUSION Our study provides additional support for nonlinear burst SCS by showing this therapy improves patients' mental and physical health and quality of life. These results provide evidence that this stimulation design acts upon motivational-affective responses of pain through the medial spinothalamic tract.

Spinal Cord Stimulation for Chronic Pain Relief: First Experience in Baltics

2011 ◽  
Vol 11 (1) ◽  
pp. 180-181
Author(s):  
Iveta Golubovska ◽  
Aleksejs Miscuks ◽  
Vitolds Jurkevics ◽  
Sarmite Skaida
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Low Income ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Neuropathic Pain Syndrome ◽  
Patient Status ◽  
First Case

Spinal Cord Stimulation for Chronic Pain Relief: First Experience in BalticsWe report the first case of spinal cord stimulator implantation in Baltics to patient with massive posttraumatic plexus lumbosacralis dxtr lesion, severe neuropathic pain syndrome and drug addiction problems. Follow-up time is 6 month since December 2011 and we have observed an obvious clinical and social improvement in patient status. Besides significant pain relief she has got employed and is tax payer instead of low-income person.

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