Spinal Cord Stimulation for Chronic, Intractable Pain

Abstract

Over the past two decades, spinal cord stimulation devices and techniques have evolved from single-channel systems, with electrodes requiring laminectomy, into programmable "multichannel" systems with electrodes that may be placed percutaneously. We have reviewed our experience in 320 consecutive patients treated with these devices at our institution between 1972 and 1990. Technical details of treatment as well as patient characteristics have been assessed as predictors of clinical outcome and of hardware reliability by univariate and multivariate statistical methods. Current follow-up has been obtained at intervals from 2 to 20 years (mean, 7.1 yr) postoperatively on 205 patients. All clinical outcome measures have been based on disinterested third-party interview data--standard analog pain ratings, employment status, activities of daily living, and use of analgesics. At 7-year mean follow-up, 52% of the 171 patients who received permanent implants reported at least 50% continued pain relief. A majority had maintained improvements in activities of daily living and analgesic use. Analysis of hardware reliability for 298 permanent implants revealed significantly fewer clinical failures (P < 0.001) and technical failures (in particular, electrode migration and malposition, P = 0.025) as single-channel implants have evolved into programmable, multichannel devices. Our analysis of technical and clinical prognostic factors may be useful to the clinician in selecting patients for this procedure.

Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation

“…We applied 1-s frequencies of 4,096-32,768 Hz, introducing up to 5,000 mW into the muscles. High-frequency electrical spinal cord stimulation with implanted electrodes has previously been shown to be effective in the relief of chronic diabetic neuropathic pain [8] and several other chronic painful conditions, including back pain, phantom-limb pain, peripheral vascular disease and severe angina [19,20]. Whereas this procedure is not free of risk and may give rise to life-threatening infection [21], the HF treatment used in our study is safe and may potentially be used for other chronic pain indications.…”

Spinal cord stimulation in chronic pain syndromes

“…Although new electrode designs may o er the opportunity for good results in this region as well, axial pain is commonly thought to be of nociceptive origin and may be less responsive to spinal cord stimulation than is pain associated with dea erentiation or neural injury. 44 Despite the extensive literature on SCS for FBSS, only one randomized study has yet been performed. 45 In this study SCS was compared to re-operation in patients with persistent radicular pain (with and without low back pain) following lumbosacral spine surgery.…”

The threshold current in the intrathecal space to elicit motor response is lower and does not overlap that in the epidural space: a porcine model

“…[14][15][16] It has been applied to neural structures for neurophysiologic assessment, used as an effective method of pain management, and accepted as a useful tool for peripheral nerve location when performing regional anesthesia. [14][15][16] The use of ES to confirm the location of the epidural space (Tsui test) has only recently been described. [7][8][9][10][11][12] This test appears to reliably confirm caudal, lumbar and thoracic epidural catheter placement in pediatric, obstetric and postoperative patients.…”