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da Cunha PHM, de Andrade DC. The deep and the deeper: Spinal cord and deep brain stimulation for neuropathic pain. Presse Med 2024; 53:104231. [PMID: 38636785 DOI: 10.1016/j.lpm.2024.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Neuropathic pain occurs in people experiencing lesion or disease affecting the somatosensorial system. It is present in 7 % of the general population and may not fully respond to first- and second-line treatments in up to 40 % of cases. Neuromodulation approaches are often proposed for those not tolerating or not responding to usual pharmacological management. These approaches can be delivered surgically (invasively) or non-invasively. Invasive neuromodulation techniques were the first to be employed in neuropathic pain. Among them is spinal cord stimulation (SCS), which consists of the implantation of epidural electrodes over the spinal cord. It is recommended in some guidelines for peripheral neuropathic pain. While recent studies have called into question its efficacy, others have provided promising data, driven by advances in techniques, battery capabilities, programming algorithms and software developments. Deep brain stimulation (DBS) is another well-stablished neuromodulation therapy routinely used for movement disorders; however, its role in pain management remains limited to specific research centers. This is not only due to variable results in the literature contesting its efficacy, but also because several different brain targets have been explored in small trials, compromising comparisons between these studies. Structures such as the periaqueductal grey, posterior thalamus, anterior cingulate cortex, ventral striatum/anterior limb of the internal capsule and the insula are the main targets described to date in literature. SCS and DBS present diverse rationales for use, mechanistic backgrounds, and varying levels of support from experimental studies. The present review aims to present their methodological details, main mechanisms of action for analgesia and their place in the current body of evidence in the management of patients with neuropathic pain, as well their particularities, effectiveness, safety and limitations.
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Affiliation(s)
| | - Daniel Ciampi de Andrade
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Bean LL, Goon M, McClure JJ, Aguiar RST, Kato N, DiMarzio M, Pilitsis JG. The Evolution of Surgical Technique in Spinal Cord Stimulation: A Scoping Review. Oper Neurosurg (Hagerstown) 2024; 26:372-380. [PMID: 37976139 DOI: 10.1227/ons.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/29/2023] [Indexed: 11/19/2023] Open
Abstract
Since the advent of spinal cord stimulation (SCS), its operative technique has consistently advanced. We performed a scoping review of the literature regarding SCS operative techniques to highlight key advancements. To review, summarize, and highlight key changes in SCS implantation techniques since their inception. The authors performed a MEDLINE search inclusive of articles from 1967 to June 2023 including human and modeling studies written in English examining the role of trialing, intraoperative neuromonitoring, and surgical adaptations. Using the Rayyan platform, two reviewers performed a blinded title screen. Of the 960 articles, 197 were included in the title screen, 107 were included in the abstract review, and ultimately 69 articles met inclusion criteria. We examined the utility of trialing and found that historical controls showed significant efficacy, whereas recent results are more equivocal. We discuss the significant improvement in outcomes with intraoperative neuromonitoring for asleep SCS placement. We highlight technique improvements that led to significant reductions in infection, lead migration, and inadequate pain relief. Physicians implanting SCS systems for chronic pain management must continually refine their surgical techniques to keep up with this rapidly evolving therapy. In addition, through collaborative efforts of neuromodulators and industry, SCS is safer and more effective for patients suffering from chronic pain.
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Affiliation(s)
- Lindsay L Bean
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Madison Goon
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Jesse J McClure
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Rodrigo S T Aguiar
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Nicholas Kato
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Marisa DiMarzio
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
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Boulton AJM, Jensen TS, Luecke T, Petersen EA, Pop-Busui R, Taylor RS, Tesfaye S, Vileikyte L, Ziegler D. Where does spinal cord stimulation fit into the international guidelines for refractory painful diabetic neuropathy? a consensus statement. Diabetes Res Clin Pract 2023; 206 Suppl 1:110763. [PMID: 38245326 DOI: 10.1016/j.diabres.2023.110763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Although pharmacotherapy with anticonvulsants and/or antidepressants can be effective for many people with painful diabetic neuropathy (PDN), albeit with frequent side-effects, a critical juncture occurs when neuropathic pain no longer responds to standard first- and second-step mono- and dual therapy and becomes refractory. Subsequent to these pharmacotherapeutic approaches, third-line treatment options for PDN may include opioids (short-term), capsaicin 8% patches, and spinal cord stimulation (SCS). AIM This document summarizes consensus recommendations regarding appropriate treatment for refractory peripheral diabetic neuropathy (PDN), based on outcomes from an expert panel convened on December 10, 2022, as part of the Worldwide Initiative for Diabetes Education Virtual Global Summit, "Advances in the Management of Painful Diabetic Neuropathy." PARTICIPANTS Nine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert. EVIDENCE For individuals with refractory PDN, opioids are a high-risk option that do not provide a long-term solution and should not be used. For appropriately selected individuals, SCS is an effective, safe, and durable treatment option. In particular, high-frequency (HF) SCS (10 kHz) shows strong efficacy and improves quality of life. To ensure treatment success, strict screening criteria should be used to prioritize candidates for SCS. CONSENSUS PROCESS Each participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting. CONCLUSION Globally, the use of opioids should rarely be recommended for refractory, severe PDN. Based on increasing clinical evidence, SCS, especially HF-SCS, should be considered as a treatment for PDN that is not responsive to first- or second-line monotherapy/dual therapy.
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Affiliation(s)
| | - T S Jensen
- International Diabetic Neuropathy Consortium, Aarhus University, Aarhus, Denmark
| | - T Luecke
- Pain Center, Franziskus Hospital Linz, Vice President, German Pain Society, Linz am Rhein, Germany
| | - E A Petersen
- University of Arkansas for Medical Sciences, AR, USA
| | - R Pop-Busui
- Metabolism, Endocrinology, and Diabetes, University of Michigan, MI, USA
| | | | - S Tesfaye
- Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, UK
| | | | - D Ziegler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
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Hagedorn JM, Tate J, Bharara M. Patient-Reported Satisfaction with Using a Rechargeable 10 kHz Spinal Cord Stimulation Device. J Pain Res 2023; 16:47-53. [PMID: 36636269 PMCID: PMC9829980 DOI: 10.2147/jpr.s374499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/08/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Chronic pain is a common clinical condition and is frequently treated with a variety of medications, but pharmacotherapy is oftentimes not the optimal long-term treatment option. Safe and effective long-term pain relief for trunk and limb pain is available using high-frequency spinal cord stimulation at 10 kHz (10 kHz SCS), which is delivered using a rechargeable implantable pulse generator (IPG). Although rechargeable devices have been shown to reduce patient risk and overall cost by eliminating the need for periodic surgeries to replace depleted non-rechargeable IPGs, there is little published evidence that rechargeable technology is practical and convenient for patients, especially in the context of 10 kHz SCS. Objective This analysis of real-world patients implanted with 10 kHz SCS devices was undertaken using patient data from an industry-maintained database to investigate whether there was a substantial burden associated with rechargeable SCS and the degree of patient satisfaction or dissatisfaction with 10 kHz SCS. Results This study included 10,391 men and women who were implanted with 10 kHz SCS devices to treat chronic pain of the trunk and/or limbs. They received stimulation for a median of 361 days (180-1550 days), and 65.48% had previous spine surgery. In this patient sample, most patients were satisfied with the efficacy of 10 kHz SCS, including 77% who would repeat the procedure and 71% who would recommend it to other patients with similar pain. In regards to IPG recharging, 70% were satisfied or very satisfied and 19% were neutral, and a majority of patients recharged their device daily for 30 to 60 minutes. Conclusion These results indicate most patients do not find IPG recharging inconvenient or burdensome. In addition, IPG recharging is not a barrier to the majority of patients benefitting from 10 kHz SCS for long-term pain relief.
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Affiliation(s)
- Jonathan M Hagedorn
- iSpine Pain Physicians, Maple Grove, MN, USA,Correspondence: Jonathan M Hagedorn, iSpine Pain Physicians, Maple Grove, MN, USA, Tel +1 763-201-8191, Fax +1 763-201-8192, Email
| | | | - Manish Bharara
- Clinical Affairs Department, Nevro Corp, Redwood City, CA, USA
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Goudman L, Rigoard P, Billot M, Duarte RV, Eldabe S, Moens M. Patient Selection for Spinal Cord Stimulation in Treatment of Pain: Sequential Decision-Making Model - A Narrative Review. J Pain Res 2022; 15:1163-1171. [PMID: 35478997 PMCID: PMC9035681 DOI: 10.2147/jpr.s250455] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/05/2022] [Indexed: 01/09/2023] Open
Abstract
Despite the well-known efficacy of spinal cord stimulation (SCS) in chronic pain management, patient selection in clinical practice remains challenging. The aim of this review is to provide an overview of the factors that can influence the process of patient selection for SCS treatment. A sequential decision-making model is presented within a tier system that operates in clinical practice. The first level incorporates the underlying disease as a primary indication for SCS, country-related reimbursement rules, and SCS screening-trial criteria in combination with underlying psychological factors as initial selection criteria in evaluating patient eligibility for SCS. The second tier is aligned with the individualized approach within precision pain medicine, whereby individual goals and expectations and the potential need for preoperative optimizations are emphasized. Additionally, this tier relies on results from prediction models to provide an estimate of the efficacy of SCS in the long term. In the third tier, selection bias, MRI compatibility, and ethical beliefs are included, together with recent technological innovations, superiority of specific stimulation paradigms, and new feedback systems that could indirectly influence the decision-making of the physician. Both patients and physicians should be aware of the different aspects that influence patient selection in relation to SCS for pain management to make an independent decision on whether or not to initiate a treatment trajectory with SCS.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium,STIMULUS Consortium (Research and Teaching Neuromodulation VUB/UZ Brussel), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, 1090, Belgium,Research Foundation — Flanders (FWO), Brussels, 1090, Belgium,Correspondence: Lisa Goudman, Department of Neurosurgery, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, Jette1090, Belgium, Tel +32-2-477-5514, Fax +32-2-477-5570, Email
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, 86021, France,Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, 86021, France,Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, 86360, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, 86021, France
| | - Rui V Duarte
- Liverpool Reviews and Implementation Group, Department of Health Data Science, University of Liverpool, Liverpool, L69 3BX, UK
| | - Sam Eldabe
- Pain Clinic, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium,STIMULUS Consortium (Research and Teaching Neuromodulation VUB/UZ Brussel), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, 1090, Belgium,Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, 1090, Belgium,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, 1090, Belgium
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