ID:16526 Transgrade Multimodal Neuromodulation of Dorsal Root Ganglion Ensemble for Refractory Neuropathic Pain: DRGON Study

Al‐Kaisy, Adnan; Pang, David; Royds, Jonathan; Palmisani, Stefano; Mullins, Cormac Francis; Palumbo, Joseph S.; Izquierdo-Barras, Alba; Sanderson, Karen; Wesley, Samuel; Al-Kaisy, Omar; Ward, Stephen G.; Yearwood, Thomas

doi:10.1016/j.neurom.2022.02.116

Cited by 3 publications

(3 citation statements)

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“…Various studies have also reported modest success in alleviating pain with epidural stimulation (Linderoth and Meyerson, 2010;Deer et al, 2014). The relatively noninvasive implantation of epidural electrodes led researchers to explore its other applications beyond pain relief (Kapural et al, 2016;Al-Kaisy et al, 2018;Deer et al, 2018). A case study including participants with chronic motor-complete SCI shows that epidural stimulation of lumbosacral spinal cord could enable them to make small leg movements with only stimulation, but when the stimulation was combined with physical training, participants was able to sustain contractions and generate force during leg flexion exercise (Angeli et al, 2014).…”

Section: Enhancing the Therapeutic Efficacy Of Nspcs With Neuromodula...mentioning

confidence: 99%

Combinatorial strategies for cell transplantation in traumatic spinal cord injury

Jagrit,

Koffler,

Dulin

2024

Front. Neurosci.

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Spinal cord injury (SCI) substantially reduces the quality of life of affected individuals. Recovery of function is therefore a primary concern of the patient population and a primary goal for therapeutic interventions. Currently, even with growing numbers of clinical trials, there are still no effective treatments that can improve neurological outcomes after SCI. A large body of work has demonstrated that transplantation of neural stem/progenitor cells (NSPCs) can promote regeneration of the injured spinal cord by providing new neurons that can integrate into injured host neural circuitry. Despite these promising findings, the degree of functional recovery observed after NSPC transplantation remains modest. It is evident that treatment of such a complex injury cannot be addressed with a single therapeutic approach. In this mini-review, we discuss combinatorial strategies that can be used along with NSPC transplantation to promote spinal cord regeneration. We begin by introducing bioengineering and neuromodulatory approaches, and highlight promising work using these strategies in integration with NSPCs transplantation. The future of NSPC transplantation will likely include a multi-factorial approach, combining stem cells with biomaterials and/or neuromodulation as a promising treatment for SCI.

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Section: Enhancing the Therapeutic Efficacy Of Nspcs With Neuromodula...mentioning

confidence: 99%

Combinatorial strategies for cell transplantation in traumatic spinal cord injury

Jagrit,

Koffler,

Dulin

2024

Front. Neurosci.

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“…The inclusion criteria in both studies merely mentions "chronic intractable pain of the trunk and/or limbs, refractory to conservative therapy for 3 months". Other studies of HF-SCS have examined the effect of varying frequencies on pain control, yet pain is either unspecified or of different cause like Failed Back Surgery Syndrome (43,44). Yamada et al presents a case report on a 69-year old male with several bilateral upper limb pain from a C4 SCI who underwent 1-kHz HF-SCS (45).…”

Section: High-frequency Spinal Cord Stimulationmentioning

confidence: 99%

Narrative review of current neuromodulation modalities for spinal cord injury

Medina

Reddy

et al. 2023

Front. Pain Res.

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Neuromodulation is a developing field of medicine that includes a vast array of minimally invasive and non-invasive therapies including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), peripheral nerve stimulation, and spinal cord stimulation (SCS). Although the current literature surrounding the use of neuromodulation in managing chronic pain is abundant, there is an insufficient amount of evidence specifically regarding neuromodulation in patients with spinal cord injury (SCI). Given the pain and functional deficits that these patients face, that are not amenable to other forms conservative therapy, the purpose of this narrative review is to examine and assess the use of various neuromodulation modalities to manage pain and restore function in the SCI population. Currently, high-frequency spinal cord stimulation (HF-SCS) and burst spinal cord stimulation (B-SCS) have been shown to have the most promising effect in improving pain intensity and frequency. Additionally, dorsal root ganglion stimulation (DRG-S) and TMS have been shown to effectively increase motor responses and improve limb strength. Although these modalities carry the potential to enhance overall functionality and improve a patient's degree of disability, there is a lack of long-term, randomized-controlled trials in the current space. Additional research is warranted to further support the clinical use of these emerging modalities to provide improved pain management, increased level of function, and ultimately an overall better quality of life in the SCI population.

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“…An alternative SCS modality, known as paresthesia-free SCS, uses parameter settings below the patient's perception level, which does not evoke paresthesia, and when done properly can still provide strong pain relief after a wash-in period. Contemporary paresthesia-free therapies are also characterized by static pulses, typically at high frequencies (500 Hz or greater up to 10 kHz) (27)(28)(29) or burst stimulation (25,26). More recently, profound and fast (within minutes) pain relief was achieved using a sub-perception method at low frequencies (15).…”

Section: Introductionmentioning

confidence: 99%

Exploratory evaluation of spinal cord stimulation with dynamic pulse patterns: a promising approach to improve stimulation sensation, coverage of pain areas, and expected pain relief

Zhu,

Esteller,

Block

et al. 2024

Front. Pain Res.

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BackgroundThe societal burden of chronic pain and the contribution-in-part to the opioid crisis, is a strong motivation to improve and expand non-addictive treatments, including spinal cord stimulation (SCS). For several decades standard SCS has consisted in delivery of tonic pulses with static parameter settings in frequency, pulse width, and amplitude. These static parameters have limited ability to personalize the quality of paresthesia, the dermatomal coverage, and thus may affect SCS efficacy. Further, static settings may contribute to the build-up of tolerance or loss of efficacy of the therapy over time in some patients.MethodsWe conducted an acute exploratory study to evaluate the effects of SCS using time-dynamic pulses as compared to time-static (conventional tonic) stimulation pulses, with the hypotheses that dynamic pulse SCS may enable beneficial tailoring of the sensation and the patient's expectation for better pain relief with SCS. During a single clinic visit, consented subjects undergoing a standard SCS trial had their implanted leads temporarily connected to an investigational external stimulator capable of delivering time-static and six categories of time-dynamic pulse sequences, each characterized by continuously varying a stimulation parameter. Study subjects provided several assessments while blinded to the stimulation pattern, including: drawing of paresthesia maps, descriptions of sensation, and ratings for comfort and helpfulness to pain relief.ResultsEven without optimization of the field location, a majority of subjects rated sensations from dynamic stimulation as better or equal to that of static stimulation for comfortableness and for helpfulness to pain relief. The initial data showed a gender and/or pain dermatomal location related preference to a stimulation pattern. In particular, female subjects and subjects with pain at higher dermatomes tended to rank the sensation from dynamic stimulation better. Dynamic stimulation produced greater pain coverage without optimization; in 70% (9/13) of subjects, maximal pain coverage was achieved with a dynamic stimulation pattern. There was also greater variety in the words used by patients to describe stimulation sensation in the free text and free form verbal descriptions associated with dynamic stimulation.ConclusionsWith the same electrode configuration and comparable parameter settings, acute SCS using dynamic pulses produced more positive ratings, expanded paresthesia coverage, and greater variation in sensation as compared to SCS using static pulses, suggesting that dynamic stimulation has the potential to improve capabilities of SCS for the treatment of chronic pain. Further study is warranted. Trial RegistrationThis study was registered at ClinicalTrials.gov under ID NCT02988713, November 2016 (URL: https://clinicaltrials.gov/ct2/show/NCT02988713).

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ID:16526 Transgrade Multimodal Neuromodulation of Dorsal Root Ganglion Ensemble for Refractory Neuropathic Pain: DRGON Study

Cited by 3 publications

References 0 publications

Combinatorial strategies for cell transplantation in traumatic spinal cord injury

Combinatorial strategies for cell transplantation in traumatic spinal cord injury

Narrative review of current neuromodulation modalities for spinal cord injury

Exploratory evaluation of spinal cord stimulation with dynamic pulse patterns: a promising approach to improve stimulation sensation, coverage of pain areas, and expected pain relief

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