Effects of Tonic Spinal Cord Stimulation on Sensory Perception in Chronic Pain Patients: A Systematic Review

Bordeleau, Maude; Cottin, Sylvine Carrondo; Meier, Kaare; Prudhomme, Michel

doi:10.1111/ner.12893

Cited by 10 publications

(8 citation statements)

References 64 publications

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“…Future studies should confirm the external validity of our findings to other SCS devices that deliver other unique waveforms such as tonic stimulation, 33,34 BurstDR stimulation (Abbott, Plano, TX), 35 and differential target multiplexed stimulation (Medtronic, Minneapolis, MN). 36 The high number of procedural complications is concerning and adherence to proper technique and optimizing surgical, provider, and patient-related factors may help to reduce these complications.…”

Section: Discussionsupporting

confidence: 59%

Adverse Events Associated With 10-kHz Dorsal Column Spinal Cord Stimulation

D’Souza¹,

Olatoye²,

Butler³

et al. 2022

The Clinical Journal of Pain

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Background: High-frequency (10-kHz) spinal cord stimulation (SCS) continues to be an emerging therapy in chronic pain management. The same complications that plagued earlier SCS systems may affect newer stimulation technologies, although there is limited data on the type of complications and surgical management of these complications. Objective: The aim of this study was to systematically examine real-world complications associated with 10-kHz SCS reported on the Manufacturer and User Facility Device Experience (MAUDE) database. Materials and Methods: The MAUDE database was queried for entries reported between January 1, 2016 and December 31, 2020. Entries were classified into procedural complications, device-related complications, patient complaints, surgically managed complications, serious adverse events, and/or other complications. Primary outcomes included type and frequency of complications, and surgical management of complications. Results: A total of 1651 entries were analyzed. Most entries were categorized as procedural complications (72.6%), followed by serious adverse events (10.5%), device-related complications (10.5%), and patient complaints (9.9%). Most complications were managed surgically with explant (50.9%) rather than revision (5.0%) or incision/drainage (6.6%). Of procedural complications, the most common entries included non-neuraxial infection (52.9%), new neurological symptoms (14.7%), and dural puncture (9.5%). Of device-related complications, the most common entries included lead damage (41.6%), erosion (18.5%), and difficult insertion (11.5%). Conclusion: This retrospective 5-year analysis of complications from10-kHz SCS provides a real-world assessment of safety data unique for this stimulation modality. This analysis may help inform future clinical decisions, lead to device enhancement and optimization, and improve mitigation of risks to provide safe and efficacious use of 10-kHz SCS.

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Section: Discussionsupporting

confidence: 59%

Adverse Events Associated With 10-kHz Dorsal Column Spinal Cord Stimulation

D’Souza¹,

Olatoye²,

Butler³

et al. 2022

The Clinical Journal of Pain

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“…With this in mind, HFS waveform (sub-perceptional/ paresthesia-free) was compared to conventional tonic SCS and SCS "off " in a single-center trial including a broad variety of chronic pain disorders such as FBSS, migraine, neuritis and CRPS with SCS leads implanted at different spine levels (cervical-thoracic-occipital). Compared to tonic SCS and "off " SCS, HFS exhibited the most prominent effects by increasing mechanical detection thresholds, pressure pain and vibration detection thresholds suggesting a different pathway through which HFS may modulate the sensorimotor system [17,58].…”

Section: Comparison With Published Human Clinical Scs Trials Assessinmentioning

confidence: 95%

“…Furthermore, the authors recommended to standardize such issues, as they bias the value and results of the published QST-SCS trials and to explore novel, alternative SCS waveforms. Notably, in all studies it could not be excluded, that SCS exerted its effect on the contralateral non-painful extremity, hence interfering with QST measurements in a broader sense, while in contrast selective DRG stimulation may have the potential to overcome such limiting concerns [58].…”

Section: Comparison With Published Human Clinical Scs Trials Assessinmentioning

confidence: 97%

“…According to the published QST studies assessing possible relationships between tonic SCS waveform and sensorimotor phenotyping, Bordeleau and colleagues concluded, that it is more likely that tonic SCS did not interfere with perception of external stimuli (experimental pain) due to the broad range of pain disorders included, different applied methodologies of QST (different devices) and heterogeneous study protocols (design, comparator, observation period, tested body area) [58]. Furthermore, the authors recommended to standardize such issues, as they bias the value and results of the published QST-SCS trials and to explore novel, alternative SCS waveforms.…”

Section: Comparison With Published Human Clinical Scs Trials Assessinmentioning

confidence: 99%

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Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation

et al. 2020

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Background In a previous study, we reported that selective dorsal root ganglion stimulation (DRGSTIM) at DRG level L4 promoted a favorable outcome for complex regional pain syndrome (CRPS) patients along with DRGSTIM-related changes of inflammatory biomarkers in blood and saliva. The impact on somatosensation is largely unknown. Herein, we assessed the quantitative sensory profile to quantify L4-DRGSTIM effects in CRPS patients. Methods Twelve refractory CRPS patients (4 female; 8 male; mean age 69 ± 9 years) received standardized quantitative sensory testing (QST) protocol at baseline and after 3 months of unilateral L4-DRGSTIM assessing nociceptive and non-nociceptive thermal and mechanical sensitivity of the knee affected by CRPS and the contralateral non-painful knee area. Results At baseline, CRPS subjects showed significantly increased thresholds for warmth, tactile and vibration detection (WDT, MDT and VDT) and exaggerated pain summation (WUR). After 3 months of unilateral L4-DRGSTIM all pain parameters exhibited trends towards normalization of sensitivity accumulating to a significant overall normalization for pain sensitivity (effect size: 0.91, p < 0.01), while with the one exception of WDT all non-nociceptive QST parameters remained unchanged. Overall change of non-nociceptive detection was negligible (effect size: 0.25, p > 0.40). Notably, reduction of pain summation (WUR) correlated significantly with pain reduction after 3 months of L4-DRGSTIM. Conclusions Selective L4-DRGSTIM lowered ongoing pain in CRPS patients and evoked significant normalization in the pain domain of the somatosensory profile. Thermoreception and mechanoreception remained unchanged. However, larger randomized, sham-controlled trials are highly warranted to shed more light on effects and mechanisms of dorsal root ganglion stimulation on quantitative sensory characteristics. The study protocol was registered at the 15.11.2016 on German Register for Clinical Trials (DRKS ID 00011267). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011267

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“…Although SCS is a suitable therapy for many CLBP patients, 13–15 there is a considerable proportion of patients who are not helped enough 16–18 . QST studies in CLBP patients implanted with SCS systems have reported no consistent significant effect of SCS on the sensory processing abnormalities observed in CLBP patients 19 …”

Section: Introductionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation Normalizes Measures of Pain Processing in Patients with Chronic Low‐Back Pain: A Prospective Pilot Study using Quantitative Sensory Testing

et al. 2021

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Background Dorsal root ganglion stimulation (DRG‐S) is used as a treatment for chronic low‐back pain (CLBP), although its underlying mechanisms remain elusive. CLBP patients have been found to have reduced mechanoreceptive perception, reduced endogenous analgesia, as well as deep‐tissue hyperalgesia when compared with healthy controls. Using quantitative sensory testing (QST), we studied if DRG‐S in CLBP patients results in changes in pain processing. Methods Quantitative sensory testing was performed in patients before trial implantation of a DRG‐S system for CLBP and just before the trial lead removal or at 1‐month follow‐up after the permanent implant. We determined the pressure pain threshold (PPT) and mechanical detection threshold (MDT) at the most painful lower‐back location. PPT was also measured on the contralateral shoulder as a control. We obtained a measure of endogenous inhibitory pain modulation using conditioned pain modulation (CPM). Results We enrolled 11 patients (60 ± 16 years). Pain decreased from 8.5 ± 1.0 at baseline to 2.0 ± 1.5 on a 0‐10 numerical rating scale with DRG‐S (P < 0.01). From baseline to with DRG‐S, PPT on the most painful location on the low back increased from 28.7 ± 13.6 to 43.4 ± 17.2 N/cm2 (P < 0.01). MDT on the same location decreased from 8.1 ± 10.4 to 3.4 ± 4.7 mN (P = 0.07). PPT on the control location and CPM did not change significantly. Conclusions Our results suggest that DRG‐S in CLBP patients reduces deep‐tissue hyperalgesia in the low back, while improving mechanoreceptive perception. These changes in both neuropathic and nociceptive components of CLBP were accompanied by clinical improvements in pain and function.

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Effects of Tonic Spinal Cord Stimulation on Sensory Perception in Chronic Pain Patients: A Systematic Review

Cited by 10 publications

References 64 publications

Adverse Events Associated With 10-kHz Dorsal Column Spinal Cord Stimulation

Adverse Events Associated With 10-kHz Dorsal Column Spinal Cord Stimulation

Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation

Dorsal Root Ganglion Stimulation Normalizes Measures of Pain Processing in Patients with Chronic Low‐Back Pain: A Prospective Pilot Study using Quantitative Sensory Testing

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