Neuromodulation, specifically spinal cord stimulation (SCS), has become a staple of chronic pain management for various conditions including failed back syndrome, chronic regional pain syndrome, refractory radiculopathy, and chronic post operative pain. Since its conceptualization, it has undergone several advances to increase safety and convenience for patients and implanting physicians. Current research and efforts are aimed towards novel programming modalities and modifications of existing hardware. Here we review the recent advances and future directions in spinal cord stimulation including a brief review of the history of SCS, SCS waveforms, new materials for SCS electrodes (including artificial skins, new materials, and injectable electrodes), closed loop systems, and neurorestorative devices.

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a cause of chronic abdominal pain in which nerves become pathologically entrapped and irritated, leading to pain.  The prevalence of the syndrome is 15 to 30 percent, and many treatment approaches begin with pharmacologic therapy.  If pharmacologic therapy fails, trigger point injections, nerve blocks, and neurectomy are subsequent therapeutic options.  We present the case of a 50-year-old female with chronic abdominal pain and steroid allergy who presented to the pain clinic after failed mainstay therapy including gabapentin, amitriptyline, nortriptyline, duloxetine, NSAID, and acetaminophen.  She was diagnosed with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES).  A primary intervention of Bilateral Transversus Abdominis Plane (TAP) Block with local anesthetic provided 80% pain relief.  Following successful primary intervention, a secondary intervention of Pulsed Radiofrequency Ablation (PRF) provided pain relief for 2 months.