Efficacy of Alternating Conventional Stimulation and High Frequency Stimulation in Improving Spinal Cord Stimulation Outcomes: A Pilot Study

2018 ◽  
Vol 21 (5) ◽  
pp. 466-471 ◽  
Author(s):  
Vignessh Kumar ◽  
Julia Prusik ◽  
Yufan Lin ◽  
Roy Hwang ◽  
Paul Feustel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pilot Study ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
High Frequency Stimulation ◽  
Frequency Stimulation

scholarly journals Effectiveness of Spinal Cord Stimulation in Chronic Spinal Pain: A Systematic Review

2016 ◽  
Vol 1;19 (1;1) ◽  
pp. E33-E54
Author(s):  
Jay Grider
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Spinal Pain ◽  
High Frequency Stimulation ◽  
Burst Stimulation ◽  
High Quality ◽  
Frequency Stimulation ◽  
Level I ◽  
Chronic Spinal Pain

Background: Chronic neuropathic pain has been recognized as contributing to a significant proportion of chronic pain globally. Among these, spinal pain is of significance with failed back surgery syndrome (FBSS), generating considerable expense for the health care systems with increasing prevalence and health impact. Objective: To assess the role and effectiveness of spinal cord stimulation (SCS) in chronic spinal pain. Study Design: A systematic review of randomized controlled trials (RCTs) of SCS in chronic spinal pain. Methods: The available literature on SCS was reviewed. The quality assessment criteria utilized were Cochrane review criteria to assess sources of risk of bias and Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment (IPM – QRB) criteria for randomized trials. The level of evidence was based on a best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. Data sources included relevant literature published from 1966 through March 2015 that were identified through searches of PubMed and EMBASE, manual searches of the bibliographies of known primary and review articles, and all other sources. Outcome Measures: RCTs of efficacy with a minimum 12-month follow-up were considered for inclusion. For trials of adaptive stimulation, high frequency stimulation, and burst stimulation, shorter follow-up periods were considered. Results: Results showed 6 RCTs with 3 efficacy trials and 3 stimulation trials. There were also 2 cost effectiveness studies available. Based on a best evidence synthesis with 3 high quality RCTs, the evidence of efficacy for SCS in lumbar FBSS is Level I to II. The evidence for high frequency stimulation based on one high quality RCT is Level II to III. Based on a lack of high quality studies demonstrating the efficacy of adaptive stimulation or burst stimulation, evidence is limited for these 2 modalities. Limitations: The limitations of this systematic review continue to require future studies illustrating effectiveness and also the superiority of high frequency stimulation and potentially burst stimulation. Conclusion: There is significant (Level I to II) evidence of the efficacy of spinal cord stimulation in lumbar FBSS; whereas, there is moderate (Level II to III) evidence for high frequency stimulation; there is limited evidence for adaptive stimulation and burst stimulation. Key words: Neuropathic pain, chronic spinal pain, failed back surgery syndrome, spinal cord stimulation, high frequency stimulation, burst stimulation, adaptive stimulation

scholarly journals Spinal cord stimulation in experimental chronic painful diabetic polyneuropathy: Delayed effect of High-frequency stimulation

2016 ◽  
Vol 21 (5) ◽  
pp. 795-803 ◽  
Author(s):  
M. van Beek ◽  
M. van Kleef ◽  
B. Linderoth ◽  
S.M.J. van Kuijk ◽  
W.M. Honig ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Diabetic Polyneuropathy ◽  
High Frequency Stimulation ◽  
Delayed Effect ◽  
Frequency Stimulation

scholarly journals Present and Potential Use of Spinal Cord Stimulation to Control Chronic Pain

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. 234-246
Author(s):  
Jason J. Song
Keyword(s):  
Spinal Cord ◽  
Peripheral Nerve ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Dorsal Root ◽  
High Frequency Stimulation ◽  
Field Stimulation ◽  
Low Back ◽  
Frequency Stimulation ◽  
Peripheral Nerve Field Stimulation

Background: Spinal cord stimulation is an intervention that has become increasingly popular due to the growing body of literature showing its effectiveness in treating pain and the reversible nature of the treatment with implant removal. It is currently approved by the FDA for chronic pain of the trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome. In Europe, it has additional approval for refractory angina pectoris and peripheral limb ischemia. Objective: This narrative review presents the current evidence supporting the use of spinal cord stimulation for the approved indications and also discusses some emerging neuromodulation technologies that may potentially address pain conditions that traditional spinal cord stimulation has difficulty addressing. Study Design: Narrative review. Results: Spinal cord stimulation has been reported to be superior to conservative medical management and reoperation when dealing with pain from failed back surgery syndrome. It has also demonstrated clinical benefit in complex regional pain syndrome, critical limb ischemia, and refractory angina pectoris. Furthermore, several cost analysis studies have demonstrated that spinal cord stimulation is cost effective for these approved conditions. Despite the lack of a comprehensive mechanism, the technology and the complexity in which spinal cord stimulation is being utilized is growing. Newer devices are targeting axial low back pain and foot pain, areas that have been reported to be more difficult to treat with traditional spinal cord stimulation. Percutaneous hybrid paddle leads, peripheral nerve field stimulation, nerve root stimulation, dorsal root ganglion, and high frequency stimulation are actively being refined to address axial low back pain and foot pain. High frequency stimulation is unique in that it provides paresthesia free analgesia by stimulating beyond the physiologic frequency range. The preliminary results have been mixed and a large randomized control trial is underway to evaluate the future of this technology. Other emerging technologies, including dorsal root ganglion stimulation and hybrid leads, also show some promising preliminary results in non-randomized observational trials. Limitation: This review is a primer and not an exhaustive review for the current evidence supporting the use of spinal cord stimulation and precursory discussion of emerging neuromodulation technologies. This review does not address peripheral nerve stimulation and focuses mainly on spinal cord stimulation and touches on peripheral nerve field stimulation. Conclusions: Spinal cord stimulation has demonstrated clinical efficacy in randomized control trials for the approved indications. In addition, several open label observational studies on peripheral nerve field stimulation, hybrid leads, dorsal root ganglion stimulation, and high frequency stimulation show some promising results. However, large randomized control trials demonstrating clear clinical benefit are needed to gain evidence based support for their use. Key words: Spinal cord stimulation, chronic pain; low back pain, high frequency stimulation, peripheral nerve field stimulation, dorsal root ganglion stimulation, failed back surgery syndrome, complex regional pain syndrome, critical limb ischemia, refractory angina pectoris

scholarly journals Stim Salvage: Case Series Reporting on the Effectiveness of Spinal Cord Stimulation Salvage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Patrick Paullus ◽  
Erika A Petersen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
New Technologies ◽  
Case Series ◽  
Low Frequency ◽  
Low Frequency Stimulation ◽  
Trial Outcomes ◽  
Frequency Stimulation ◽  
New System

Abstract INTRODUCTION Spinal cord stimulation (SCS) has been successfully used to treat chronic pain with improved levels of pain, decreased use of narcotic medications, and increased level of function. Nevertheless, for patients SCS benefit wares over time and maximal reprogramming may not achieve improvement. However, advancing technologies, such as burst and high-frequency modulation, offer stimulation which differs from the traditional low-frequency stimulation. For those with SCS already placed, these new technologies offer a possible avenue with which to salvage SCS loss of efficacy. In patients with the an ineffective system, a salvage trial with a new system can be performed. In these cases, their current generators are externalized and then, utilizing their current epidural array, the leads are connected to a new trial system. These patients return to the OR in about 1 wk time for either permanent implantation or removal of the remainder of their old system. The results of these salvage trials are presented. METHODS We reviewed serially treated patients with previously placed SCS who were taken to the operating room for a salvage trial. All patient had their SCS leads externalized and connected to a different system. Changes in VAS, functional status, the trial outcomes led to permanent placement were collected retrospectively. RESULTS Results of 15 patient who underwent SCS externalization trial between 2016 and 2019 are summarized. Trial failure rate, salvage SCS response rate, changes in VAS, and patient satisfaction with the new system are reviewed. Successful salvage was accomplished in 93%. CONCLUSION New stimulation paradigms such as burst and high frequency offer a new avenue of effective treatment for those with an ineffective SCS systems. When a patient's device is unable to deliver these paradigms, an IPG-externalization trial may be a low risk option for salvaging therapy.

scholarly journals Low Doses of Fentanyl Block Central Sensitization in the Rat Spinal Cord In Vivo

2004 ◽  
Vol 100 (6) ◽  
pp. 1545-1551 ◽  
Author(s):  
Justus Benrath ◽  
Christina Brechtel ◽  
Eike Martin ◽  
Jürgen Sandkühler
Keyword(s):  
Spinal Cord ◽  
High Frequency ◽  
Long Term Potentiation ◽  
High Frequency Stimulation ◽  
Low Doses ◽  
Term Potentiation ◽  
C Fiber ◽  
Frequency Stimulation

Background mu-Opioid receptor agonists are strong analgesics. However, their usefulness for preemptive analgesia is controversial. The authors tested antinociceptive and preemptive properties of fentanyl as a mu-opioid receptor agonist in a model of spinal nociception in vivo. Methods C fiber-evoked potentials were recorded in the superficial laminae I-II of the rat lumbar spinal cord with glass microelectrodes in response to electrical stimulation of the sciatic nerve. High-frequency stimulation was applied on the sciatic nerve to induce long-term potentiation of C fiber-evoked field potentials, a form of central sensitization. To test the effect of fentanyl on acute nociception, fentanyl was infused intravenously at increasing doses (6-192 microg.kg(-1).h(-1)). One hour after start of infusion, high-frequency stimulation was applied to evaluate effects of fentanyl on the induction of long-term potentiation. Results In the absence of fentanyl, high-frequency stimulation potentiated C fiber-evoked field potentials to 149 +/-12% of controls (mean +/-SEM; n = 6) for at least 1 h. Increasing doses of fentanyl led to a significant reduction of C fiber-evoked potentials in a dose-dependent manner. The induction of long-term potentiation was blocked by low doses of fentanyl (infusion 12-48 microg.kg(1).h(-1)). At high doses, fentanyl did not block the induction of long-term potentiation (infusion 96-192 microg.kg(-1).h(-1)). Conclusions : Low doses of fentanyl block the synaptic form of central sensitization in the rat spinal cord in vivo, but higher doses do not have this effect.

Depression of postsynaptic potentials by high-frequency stimulation in embryonic motoneurons grown in spinal cord slice cultures

1992 ◽  
Vol 68 (5) ◽  
pp. 1793-1803 ◽  
Author(s):  
J. Streit ◽  
C. Luscher ◽  
H. R. Luscher
Keyword(s):  
Spinal Cord ◽  
Dorsal Root Ganglia ◽  
High Frequency ◽  
Dorsal Root ◽  
Input Resistance ◽  
Synaptic Depression ◽  
High Frequency Stimulation ◽  
Postsynaptic Potentials ◽  
Wide Range ◽  
Frequency Stimulation

1. In embryonic cocultures of spinal cord, dorsal root ganglia, and muscle, excitatory postsynaptic potentials (EPSPs) were recorded in motoneurons during focal electrical stimulation of the dorsal root ganglia or the spinal cord. 2. EPSPs were depressed in amplitude at high-frequency stimulation relative to a control frequency of 0.5 Hz by 47 and 75% at 5 and 10 Hz, respectively. This was true for composite EPSPs and unitary EPSPs. 3. The depression showed a wide range of variability between individual experiments. The degree of depression at 5 Hz was negatively correlated to the rate of spontaneous excitatory input the motoneurons received. There was no correlation to the soma size, the average amplitude of the EPSPs, the rheobase, or the input resistance of the motoneurons. 4. An increase in latency of EPSPs was observed concomitant with or preceding the synaptic depression in most experiments. Total transmission failures, which were absent at low-frequency stimulation, appeared during depression. 5. Large incremental steps in amplitude could be seen during depression, suggesting that several release sites were switched off and on together. 6. Decreasing the extracellular calcium concentration from 5 to 1 mM led to a decrease in the frequency sensitivity of the synaptic efficacy and to a decrease of the EPSP amplitude and latency. 7. Measurements of the antidromic conduction of action potentials evoked in the axons and recorded in the somata of dorsal root ganglion cells revealed an increase in latency and the appearance of conduction failures at stimulation frequencies of 1-10 Hz. The frequency modulation of conduction was decreased in 1 mM compared with 5 mM external calcium. 8. Together these findings suggest that conduction failures in the presynaptic axons contribute to the synaptic depression of EPSPs in embryonic motoneurons.

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