scholarly journals Use of Observational Mechanical Gateway Connector in Spinal Cord Stimulation Trials

2011 ◽  
Vol 6;14 (6;12) ◽  
pp. 525-530
Author(s):  
Chong H. Kim
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Score ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Dorsal Column ◽  
Small Sample ◽  
Constant Current ◽  
Average Pain ◽  
Average Pain Score

Background: Spinal cord stimulation (SCS) is an established treatment option for chronic pain. Prior to permanent implantation, temporary trials are performed to evaluate the SCS treatment. Currently there are multiple manufacturers with varying fundamental differences in delivery and resultant paresthesias. However, trials are typically limited to one manufacturer for the patient to evaluate. Objective: To evaluate the role of the Observational Mechanical Gateway (OMG) Connector for patients undergoing SCS trials. Study Design: Retrospective cohort design study. Patients undergoing SCS trials were offered at the end of the 7 day trial to experience stimulation using the OMG Connector. Setting: Academic university-based pain management center. Method: Participants were trialed using the OMG Connector at the end of the 7 day spinal cord stimulation trial. Data based on participants’ preference were collected. Results: The average pain score at baseline was 7.3 on a 10-point scale overall, with improvement during the SCS trial to 2.9 overall; 3.5 in Medtronic (MT); and 2.4 in St. Jude (SJ) SCS trials (P = 0.04). The average pain score with OMG was 2.6 overall; 2.8 in MT; and 2.4 in SJ (P = 0.28). In terms of overall coverage of pain distribution, paresthesia and overall satisfaction, the P values were 0.24, 0.21 and 0.33 respectively. Overall, 12 of 16 participants underwent permanent implantation. One of the 4 failed trials was successfully retrialed with the OMG Connector. Limitations: Small sample of participants and the duration of the OMG Connector trial. Conclusions: The OMG Connector offers patients another opportunity to better access the available treatment options during the SCS trial period. Key words: Spinal cord stimulation, OMG Connector, paresthesia, neurostimulation, constant current, constant voltage, chronic pain, dorsal column

scholarly journals Modulation of activity and conduction in single dorsal column axons by kilohertz-frequency spinal cord stimulation

2017 ◽  
Vol 117 (1) ◽  
pp. 136-147 ◽  
Author(s):  
Nathan D. Crosby ◽  
John J. Janik ◽  
Warren M. Grill
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Pain Perception ◽  
Conduction Block ◽  
Dorsal Column ◽  
Platinum Electrodes ◽  
Sprague Dawley ◽  
Transient Nature ◽  
Central Nervous System Activity

Kilohertz-frequency spinal cord stimulation (KHF-SCS) is a potential paresthesia-free treatment for chronic pain. However, the effects of KHF-SCS on spinal dorsal column (DC) axons and its mechanisms of action remain unknown. The objectives of this study were to quantify activation and conduction block of DC axons by KHF-SCS across a range of frequencies (1, 5, 10, or 20 kHz) and waveforms (biphasic pulses or sinusoids). Custom platinum electrodes delivered SCS to the T10/T11 dorsal columns of anesthetized male Sprague-Dawley rats. Single DC axons and compound action potentials were recorded during KHF-SCS to evaluate SCS-evoked activity. Responses to KHF-SCS in DC axons included brief onset firing, slowly accommodating asynchronous firing, and conduction block. The effects of KHF-SCS mostly occurred well above motor thresholds, but isolated units were activated at amplitudes shown to reduce behavioral sensitivity in rats. Activity evoked by SCS was similar across a range of frequencies (5–20 kHz) and waveforms (biphasic and sinusoidal). Stimulation at 1-kHz SCS evoked more axonal firing that was also more phase-synchronized to the SCS waveform, but only at amplitudes above motor threshold. These data quantitatively characterize the central nervous system activity that may modulate pain perception and paresthesia, and thereby provide a foundation for continued investigation of the mechanisms of KHF-SCS and its optimization as a therapy for chronic pain. Given the asynchronous and transient nature of DC activity, it is unlikely that the same mechanisms underlying conventional SCS (i.e., persistent, periodic DC activation) apply to KHF-SCS. NEW & NOTEWORTHY Kilohertz-frequency spinal cord stimulation (KHF-SCS) is a new mode of SCS that may offer better pain relief than conventional SCS. However, the mechanism of action is poorly characterized, especially the effects of stimulation on dorsal column (DC) axons, which are the primary target of stimulation. This study provides the first recordings of single DC axons during KHF-SCS to quantify DC activity that has the potential to mediate the analgesic effects of KHF-SCS.

scholarly journals Comparison of FDA-Approved Electrical Neuromodulation Techniques for Focal Neuropathic Pain: A Narrative Review of DRG, HF10, and Burst Neuromodulation

2021 ◽  
pp. E407-E423
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Dorsal Root ◽  
Case Reports ◽  
Case Series ◽  
Dorsal Column ◽  
Small Sample

BACKGROUND: Evidence suggests that dorsal root ganglion stimulation (DRGS) is a more effective treatment for focal neuropathic pain (FNP) compared with tonic, paresthesia-based dorsal column spinal cord stimulation (SCS). However, new advancements in waveforms for dorsal column SCS have not been thoroughly studied or compared with DRGS for the treatment of FNP. OBJECTIVES: The purpose of this review was to examine the evidence for these novel technologies; to highlight the lack of high-quality evidence for the use of neuromodulation to treat FNP syndromes other than complex regional pain syndrome I or II of the lower extremity; to emphasize the absence of comparison studies between DRGS, burst SCS, and high-frequency SCS; and to underscore that consideration of all neuromodulation systems is more patient-centric than a one-size-fits-all approach. STUDY DESIGN: This is a review article summarizing case reports, case series, retrospective studies, prospective studies, and review articles. SETTING: The University of Miami, Florida. METHODS: A literature search was conducted from February to March 2020 using the PubMed and EMBASE databases and keywords related to DRGS, burst SCS, HF10 (high-frequency of 10 kHz), and FNP syndromes. All English-based literature from 2010 reporting clinical data in human patients were included. RESULTS: Data for the treatment of FNP using burst SCS and HF10 SCS are limited (n = 11 for burst SCS and n = 11 for HF10 SCS). The majority of these studies were small, single-center, nonrandomized, noncontrolled, retrospective case series and case reports with short follow-up duration. To date, there are only 2 randomized controlled trials for burst and HF10 for the treatment of FNP. LIMITATIONS: No studies were available comparing DRGS to HF10 or burst for the treatment of FNP. Data for the treatment of FNP using HF10 and burst stimulation were limited to a small sample size reported in mostly case reports and case series. CONCLUSIONS: FNP is a complex disease, and familiarity with all available systems allows the greatest chance of success. KEY WORDS: Dorsal root ganglion, high frequency, burst, spinal cord stimulation, neuromodulation, focal neuropathic pain

scholarly journals Importance of Axial Migration of Spinal Cord Stimulation Trial Leads with Position

2013 ◽  
Vol 6;16 (6;11) ◽  
pp. E763-E768 ◽  
Author(s):  
Chong H. Kim
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Small Sample ◽  
X Rays ◽  
Trial Period ◽  
Postural Change ◽  
Postural Changes

Background: Spinal cord stimulation (SCS) is an established treatment option for chronic pain. Prior to permanent implantation, temporary trials are performed to evaluate the SCS treatment. During the trial period, it is common for the patients to experience changes in paresthesias. However, it is unclear what the role of lead migration is, if any, in the changes in paresthesia. Objective: To evaluate the role of lead migration on the effect of postural stimulation changes during SCS trials. Study Design: Case series. Setting: University pain management center. Methods: X-rays of the patients with successful trials, in sitting and standing position, were obtained at the end of a 7 day SCS trial. Data were collected based on the need for adjustment of the stimulation settings due to changes in paresthesias with postural change of sitting versus standing. Results: The average lead migration was 3.05 mm inferiorly from a standing to sitting position for all subjects. The average migration was 2.85 mm in subjects requiring adjustment of the SCS setting due to change in paresthesia compared to 3.24 mm for those who did not require adjustment regardless of position. The results were insignificant based on P = 0.17. Limitations: Small sample size, case series. Conclusions: This case series demonstrates continued support for the role of the width of the cerebral spinal fluid space as the significant factor on paresthesia changes in SCS with respect to postural changes, even during the trial period. Key words: Spinal cord stimulation, postural change, lead migration, paresthesia, neurostimulation, chronic pain, dorsal column

scholarly journals The use of high-dose cervical spinal cord stimulation in the treatment of chronic upper extremity and neck pain

2019 ◽  
Vol 10 ◽  
pp. 109
Author(s):  
Trey A. Baird ◽  
Chris S. Karas
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Dorsal Column ◽  
High Dose ◽  
Before And After ◽  
Stage Process ◽  
Dorsal Column Stimulation

Background: Dorsal column spinal cord stimulation is used for the treatment of chronic neuropathic pain of the axial spine and extremities. Recently, high-dose (HD) thoracic dorsal column stimulation for paresthesias has been successful. This study evaluates the utility of HD stimulation in the cervical spine for managing upper neck and upper extremity pain and paresthesias. Methods: Three patients suffering from cervical and upper extremity chronic pain were assessed. Each underwent a two-stage process that included a trial period, followed by permanent stimulator implantation. Therapy included the latest HD stimulation settings including a pulse width of 90 μs, a frequency setting of 1000 Hz, and an amplitude range of 1.5 amps–2.0 amps. Pain relief was measured utilizing relative percent pain improvement as self-reported by each patient before and after surgery. Results: After permanent implantation, (range 15–21 months), all three patients continued to experience persistent pain and paresthesia relief (70%–90%). Conclusions: In three patients, HD cervical spinal cord stimulation successfully controlled upper extremity chronic pain/paresthesias.

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

Spinal Cord Stimulation for Relief of Chronic Pain in Vasospastic Disorders of the Upper Limbs

1989 ◽  
Vol 5 (2) ◽  
pp. 312
Author(s):  
F. J. ROBAINA ◽  
M. DOMINGUEZ ◽  
M. DIAZ ◽  
J. L. RODRIGUEZ ◽  
J. A. DE VERA
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Upper Limbs

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.

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