Recommendations for patient selection in spinal cord stimulation

Atkinson, Leigh; Sundaraj, Sebastian; Brooker, Charles; O’Callaghan, J.R.; Teddy, Peter J.; Salmon, John F.; Semple, Timothy; Majedi, P.M.

doi:10.1016/j.jocn.2011.02.025

Cited by 97 publications

(76 citation statements)

References 57 publications

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“…We used strict selection criteria (36) to include patients, including an NRS pain intensity $5 measured on an NRS at the lower extremities for at least 6 months, treated with best medical therapy and patients with a clear history of PDPN. Causes other than diabetic peripheral neuropathy were excluded, and if necessary, a psychological Plus-minus values are means 6 SD.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation and Pain Relief in Painful Diabetic Peripheral Neuropathy: A Prospective Two-Center Randomized Controlled Trial

et al. 2014

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OBJECTIVEPainful diabetic peripheral neuropathy (PDPN) is a common complication of diabetes mellitus. Unfortunately, pharmacological treatment is often partially effective or accompanied by unacceptable side effects, and new treatments are urgently needed. Small observational studies suggested that spinal cord stimulation (SCS) may have positive effects. RESEARCH DESIGN AND METHODSWe performed a multicenter randomized clinical trial in 36 PDPN patients with severe lower limb pain not responding to conventional therapy. Twenty-two patients were randomly assigned to SCS in combination with the best medical treatment (BMT) (SCS group) and 14 to BMT only (BMT group). The SCS system was implanted only if trial stimulation was successful. Treatment success was defined as ‡50% pain relief during daytime or nighttime or "(very) much improved" for pain and sleep on the patient global impression of change (PGIC) scale at 6 months. RESULTSTrial stimulation was successful in 77% of the SCS patients. Treatment success was observed in 59% of the SCS and in 7% of the BMT patients (P < 0.01). Pain relief during daytime and during nighttime was reported by 41 and 36% in the SCS group and 0 and 7% in the BMT group, respectively (P < 0.05). Pain and sleep were "(very) much improved" in 55 and 36% in the SCS group, whereas no changes were seen in the BMT group, respectively (P < 0.001 and P < 0.05). One SCS patient died because of a subdural hematoma. CONCLUSIONSTreatment success was shown in 59% of patients with PDPN who were treated with SCS over a 6-month period, although this treatment is not without risks.Painful diabetic peripheral neuropathy (PDPN) is a common complication of diabetes mellitus (DM), and prevalence of PDPN ranges from 10 to 26% (1-3). In many patients, the pain is of such intensity that it has a major impact on patients' health-related quality of life (HRQoL) and functional ability, including interference with general activity, mood, mobility, work, social relations, sleep, and enjoyment of life (4).

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation and Pain Relief in Painful Diabetic Peripheral Neuropathy: A Prospective Two-Center Randomized Controlled Trial

et al. 2014

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“…Таким образом, уровень доказательности исследо-ваний эффективности спинальной нейростимуляции у пациентов с КИНК недостаточен для того, чтобы признать ее основным методом выбора при этой па-тологии [3,75]. Причиной такого положения в значи-тельной мере может являться тот факт, что SCS, как правило, используется как метод «последней линии», после того как другие терапевтические методы окажут-ся недостаточно эффективными.…”

Section: Reviewsunclassified

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Ashurkov¹,

Levin²,

Murtazin³

et al. 2017

PKiK

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Critical limb ischemia (CLI) is a state of substantial reduction of blood flow in the extremities, mostly due to severe obstruction of the arteries. In lower limbs, it produces severe pain after even a short distance walk (intermittent claudication) and/or skin ulcers or sores. Surgical revascularization is a “golden standard” in CLI therapy, but it is contraindicated or not accessible for a large proportion of patients, while the medical prognosis is poor for conservative therapy. This situation stimulated the development of alternative approaches, including spinal cord stimulation (SCS) and various methods of “indirect” revascularization. In this paper, the authors give a short description of the latest approaches and a detailed review of the SCS method, while paying special attention to the studies that demonstrate not only a palliative effect of SCS (pain reduction), but also clinically significant changes in the indicators of lower limb muscles blood supply. CLI is characterized with a "vicious circle": pain causes reduced mobility and changes in the preferred limb position, which in turn lead to edema triggering an increase of ischemia and further elevation of pain. The clinical effects of SCS in CLI patients are related both with pain relief leading to a break of this vicious circle, and with the direct vasodilatory effects of the stimulation itself. There are several possible biological mechanisms of these actions, but most probably the therapeutic actions of SCS arise from their combination. Examination of different opinions about the appropriateness of spinal cord stimulation in patients with CLI, including those related to the economic efficiency of the method, leads to the conclusion that the evidence on these issues is currently insufficient. The reviewed data demonstrate the need for further development of the CLI treatment methods and high urgency of this problem.Received 6 April 2017. Accepted 23 April 2017.Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest.

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“…Since then, epidurally implanted stimulation devices have evolved significantly [2], and are now used to treat roughly 35,000 patients per year in the U.S. [19]. However, epidural SCS fails over the long term in up to half of all treated patients [6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of spinal cord stimulation profiles from intra- and extradural electrode arrangements by finite element modelling

Huang

Oya

Flouty

et al. 2014

Med Biol Eng Comput

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Spinal cord stimulation (SCS) currently relies on extradural electrode arrays that are separated from the spinal cord surface by a highly conducting layer of cerebrospinal fluid. It has recently been suggested that intradural placement of the electrodes in direct contact with the pial surface could greatly enhance the specificity and efficiency of stimulation. The present computational study aims at quantifying and comparing the electrical current distributions as well as the spatial recruitment profiles resulting from extraand intra-dural electrode arrangements. The electrical potential distribution is calculated using a 3D finite element model of the human thoracic spinal canal. The likely recruitment areas are then obtained by using the potential as input to an equivalent circuit model of the pre-threshold axonal response. The results show that the current threshold to recruitment of axons in the dorsal column is more than an order of magnitude smaller for intradural than extradural stimulation. Intradural placement of the electrodes also leads to much higher contrast between the stimulation thresholds for the dorsal root entry zone and the dorsal column, allowing better focusing of the stimulus.

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Recommendations for patient selection in spinal cord stimulation

Cited by 97 publications

References 57 publications

Spinal Cord Stimulation and Pain Relief in Painful Diabetic Peripheral Neuropathy: A Prospective Two-Center Randomized Controlled Trial

Spinal Cord Stimulation and Pain Relief in Painful Diabetic Peripheral Neuropathy: A Prospective Two-Center Randomized Controlled Trial

Spinal cord stimulation in treatment of patients with critical lower limb ischemia

Comparison of spinal cord stimulation profiles from intra- and extradural electrode arrangements by finite element modelling

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