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Bernaerts L, Roelant E, Lecomte F, Moens M, Van Buyten JP, Billet B, Bryon B, Puylaert M, Turgay T, Malone M, Theys T, Van Zundert J, Berquin A, Crombez E, De Coster O, Vangeneugden J, Ly HG, Louagie M, Hans GH. Large-scale real-world data on a multidisciplinary approach to spinal cord stimulation for persistent spinal pain syndromes: first evaluation of the Neuro-Pain ® nationwide screening and follow-up interactive register. Front Neurosci 2024; 18:1322105. [PMID: 38586192 PMCID: PMC10996860 DOI: 10.3389/fnins.2024.1322105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/26/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Spinal cord stimulation is a common treatment option for neuropathic pain conditions. Despite its extensive use and multiple technological evolutions, long term efficacy of spinal cord stimulation is debated. Most studies on spinal cord stimulation include a rather limited number of patients and/or follow-ups over a limited period. Therefore, there is an urgent need for real-world, long-term data. Methods In 2018, the Belgian government initiated a nationwide secure platform for the follow-up of all new and existing spinal cord stimulation therapies. This is a unique approach used worldwide. Four years after the start of centralized recording, the first global extraction of data was performed. Results Herein, we present the findings, detailing the different steps in the centralized procedure, as well as the observed patient and treatment characteristics. Furthermore, we identified dropouts during the screening process, the reasons behind discontinuation, and the evolution of key indicators during the trial period. In addition, we obtained the first insights into the evolution of the clinical impact of permanent implants on the overall functioning and quality of life of patients in the long-term. Discussion Although these findings are the results of the first data extraction, some interesting conclusions can be drawn. The long-term outcomes of neuromodulation are complex and subject to many variables. Future data extraction will allow us to identify these confounding factors and the early predictors of success. In addition, we will propose further optimization of the current process.
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Affiliation(s)
- Lisa Bernaerts
- Multidisciplinary Pain Center, Antwerp University Hospital, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Frederic Lecomte
- National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, University Hospital Brussels, Brussels, Belgium
| | | | - Bart Billet
- Multidisciplinary Pain Center, AZ Delta, Roeselare, Belgium
| | - Bart Bryon
- Multidisciplinary Pain Center, AZ Turnhout, Turnhout, Belgium
| | - Martine Puylaert
- Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Tuna Turgay
- Multidisciplinary Pain Center, Hôpital Erasme, ULB, Brussels, Belgium
| | - Maureen Malone
- Multidisciplinary Pain Center, AZ Klina, Brasschaat, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Van Zundert
- Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Anne Berquin
- Department of Physical and Rehabilitation Medicine, Cliniques Universitaires UCL, St. Luc, Brussels, Belgium
| | - Erwin Crombez
- Multidisciplinary Pain Center, Ghent University Hospital, Ghent, Belgium
| | | | | | - Huynh Giao Ly
- National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Marleen Louagie
- National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Guy Henri Hans
- Multidisciplinary Pain Center, Antwerp University Hospital, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, Antwerp, Belgium
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Berwal D, Quintero A, Telkes I, DiMarzio M, Harland T, Paniccioli S, Dalfino J, Iyassu Y, McLaughlin BL, Pilitsis JG. Improved Selectivity in Eliciting Evoked Electromyography Responses With High-Resolution Spinal Cord Stimulation. Neurosurgery 2024:00006123-990000000-01063. [PMID: 38376181 DOI: 10.1227/neu.0000000000002878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/29/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES As spinal cord stimulation (SCS) offers a therapy for increasing numbers of patients with chronic pain and spinal cord injury, it becomes increasingly important to better understand its somatotopy. In this prospective study, we investigate whether high-resolution SCS (HR-SCS) offers improved selectivity assessed through elicitation of evoked electromyography (EMG) responses as compared with commercial paddle leads. METHODS Vertical tripole configurations were used to elicit EMG responses in both types of paddles placed for standard-of-care indications between T6 and T10. In HR-SCS, evoked EMG responses in lower extremity/abdominal muscle groups were monitored at 6 to 8 mediolateral sites. All commercial paddle columns were tested. Percentage change in the maximum root mean square value was calculated at a group level. Heat maps were generated to identify responders for each muscle group. Responders were considered patients who had a >50% change in root mean square over baseline. RESULTS We demonstrated significantly greater motor responses across medial and lateral contacts and greater responder rates consistently at the T6 and T9 levels with HR-SCS as compared with commercial paddles in 18 patients. Distal muscle groups (gastrocnemius and tibialis anterior) and proximal muscle groups (biceps femoris and quadriceps) were selectively activated at both levels. CONCLUSION We demonstrate that HR-SCS has greater selectivity in eliciting evoked EMG responses in an intraoperative setting. HR-SCS offers recruitment of muscle groups at lateral contacts concurrently with medial contacts. We provide data that HR-SCS may provide higher spatial resolution, which has the potential to allow for personalization of care and treatment of pain syndromes/symptoms which to date have not been effectively treated.
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Affiliation(s)
- Deepak Berwal
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Alejandra Quintero
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Ilknur Telkes
- Department of Biomedical Sciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Marisa DiMarzio
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
| | - Tessa Harland
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | | | - John Dalfino
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | | | | | - Julie G Pilitsis
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, Florida, USA
- Department of Neurosurgery, University of Arizona- Tucson, Tucson, Arizona, USA
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Rigoard P, Billot M, Bougeard R, Llopis JE, Raoul S, Matis G, Vesper J, Belaïd H. Improved Outcomes and Therapy Longevity after Salvage Using a Novel Spinal Cord Stimulation System for Chronic Pain: Multicenter, Observational, European Case Series. J Clin Med 2024; 13:1079. [PMID: 38398392 PMCID: PMC10889739 DOI: 10.3390/jcm13041079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Spinal cord stimulation (SCS) is proven to effectively relieve chronic neuropathic pain. However, some implanted patients may face loss of efficacy (LoE) over time, and conversion to more recent devices may rescue SCS therapy. Recent SCS systems offer novel stimulation capabilities, such as temporal modulation and spatial neural targeting, and can be used to replace previous neurostimulators without changing existing leads. Our multicenter, observational, consecutive case series investigated real-world clinical outcomes in previously implanted SCS patients who were converted to a new implantable pulse generator. Data from 58 patients in seven European centers were analyzed (total follow-up 7.0 years, including 1.4 years after conversion). In the Rescue (LoE) subgroup (n = 51), the responder rate was 58.5% at the last follow-up, and overall pain scores (numerical rating scale) had decreased from 7.3 ± 1.7 with the previous SCS system to 3.5 ± 2.5 (p < 0.0001). Patients who converted for improved battery longevity (n = 7) had their pain scores sustained below 3/10 with their new neurostimulator. Waveform preferences were diverse and patient dependent (34.4% standard rate; 44.8% sub-perception modalities; 20.7% combination therapy). Our results suggest that patients who experience LoE over time may benefit from upgrading to a more versatile SCS system.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab, Poitiers University Hospital, 86021 Poitiers, France;
| | - Maxime Billot
- PRISMATICS Lab, Poitiers University Hospital, 86021 Poitiers, France;
| | | | | | - Sylvie Raoul
- CHU de Nantes-Hopital Laennec, 44800 Saint-Herblain, France;
| | | | - Jan Vesper
- Universitaetsklinikum Dusseldorf, 40225 Dusseldorf, Germany;
| | - Hayat Belaïd
- Fondation Adolphe de Rothschild, 75019 Paris, France;
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4
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Mao X, Chang YC, Zanos S, Lajoie G. Personalized inference for neurostimulation with meta-learning: a case study of vagus nerve stimulation. J Neural Eng 2024; 21:016004. [PMID: 38131193 DOI: 10.1088/1741-2552/ad17f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
Objective. Neurostimulation is emerging as treatment for several diseases of the brain and peripheral organs. Due to variability arising from placement of stimulation devices, underlying neuroanatomy and physiological responses to stimulation, it is essential that neurostimulation protocols are personalized to maximize efficacy and safety. Building such personalized protocols would benefit from accumulated information in increasingly large datasets of other individuals' responses.Approach. To address that need, we propose a meta-learning family of algorithms to conduct few-shot optimization of key fitting parameters of physiological and neural responses in new individuals. While our method is agnostic to neurostimulation setting, here we demonstrate its effectiveness on the problem of physiological modeling of fiber recruitment during vagus nerve stimulation (VNS). Using data from acute VNS experiments, the mapping between amplitudes of stimulus-evoked compound action potentials (eCAPs) and physiological responses, such as heart rate and breathing interval modulation, is inferred.Main results. Using additional synthetic data sets to complement experimental results, we demonstrate that our meta-learning framework is capable of directly modeling the physiology-eCAP relationship for individual subjects with much fewer individually queried data points than standard methods.Significance. Our meta-learning framework is general and can be adapted to many input-response neurostimulation mapping problems. Moreover, this method leverages information from growing data sets of past patients, as a treatment is deployed. It can also be combined with several model types, including regression, Gaussian processes with Bayesian optimization, and beyond.
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Affiliation(s)
- Ximeng Mao
- Mila-Quebec Artificial Intelligence Institute, 6666 St-Urbain, Montréal, QC H2S 3H1, Canada
- Department of Computer Science and Operations Research, University of Montréal, 2920 chemin de la Tour, Montréal, QC H3T 1J4, Canada
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States of America
- Medtronic, 710 Medtronic Parkway, Minneapolis, MN 55432, United States of America
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States of America
| | - Guillaume Lajoie
- Mila-Quebec Artificial Intelligence Institute, 6666 St-Urbain, Montréal, QC H2S 3H1, Canada
- Department of Mathematics and Statistics, University of Montréal, 2920 chemin de la Tour, Montréal, QC H3T 1J4, Canada
- Canada CIFAR AI Chair, Toronto, ON M5G 1M1, Canada
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Rigoard P, Ounajim A, Moens M, Goudman L, Roulaud M, Lorgeoux B, Baron S, Nivole K, Many M, Lampert L, David R, Billot M. Should we Oppose or Combine Waveforms for Spinal Cord Stimulation in PSPS-T2 Patients? A Prospective Randomized Crossover Trial (MULTIWAVE Study). THE JOURNAL OF PAIN 2023; 24:2319-2339. [PMID: 37473903 DOI: 10.1016/j.jpain.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/16/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
Refractory persistent spinal pain syndrome after surgery (PSPS-T2) can be successfully addressed by spinal cord stimulation (SCS). While conventional stimulation generates paresthesia, recent systems enable the delivery of paresthesia-free stimulation. Studies have claimed non-inferiority/superiority of selected paresthesia-free stimulation compared with paresthesia-based stimulation, but the comparative efficacy between different waveforms still needs to be determined in a given patient. We designed a randomized controlled 3-month crossover trial to compare pain relief of paresthesia-based stimulation versus high frequency versus burst in 28 PSPS-T2 patients implanted with multiwave SCS systems. Our secondary objectives were to determine the efficacy of these 3 waveforms on pain surface, quality of life, functional capacity, psychological distress, and validated composite multidimensional clinical response index to provide holistic comparisons at 3-, 6-, 9-, and 15-month post-randomization. The preferred stimulation modality was documented during the follow-up periods. No difference between the waveforms was observed in this study (P = .08). SCS led to significant pain relief, quality of life improvement, improvement of multidimensional clinical response index, and of all other clinical outcomes at all follow-up visits. Forty-four percent of the patients chose to keep the paresthesia-based stimulation modality after the 15-month follow-up period. By giving the possibility to switch and/or to combine several waveforms, the overall rate of SCS responders further increased with 25%. In this study, high frequency or burst do not appear superior to paresthesia-based stimulation, wherefore paresthesia-based stimulation should still be considered as a valid option. However, combining paresthesia-based stimulation with paresthesia-free stimulation, through personalized multiwave therapy, might significantly improve SCS responses. PERSPECTIVE: This article assesses clinical SCS efficacy on pain relief, by comparing paresthesia-based stimulation and paresthesia-free stimulation (including high frequency and burst) modalities in patient presenting with PSPS-T2. Switching and/or combining waveforms contribute to increasing the global SCS responders rate.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Neuro-Spine & Neuromodulation, Poitiers University Hospital, Poitiers, France; Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Kévin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Lucie Lampert
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
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Cheng Y, Xie D, Han Y, Guo S, Sun Z, Jing L, Man W, Liu D, Yang K, Lei D, Meng Z, Zhang H, Wang G, Wu W, Wang G, Lu Y. Precise management system for chronic intractable pain patients implanted with spinal cord stimulation based on a remote programming platform: study protocol for a randomized controlled trial (PreMaSy study). Trials 2023; 24:580. [PMID: 37691092 PMCID: PMC10494385 DOI: 10.1186/s13063-023-07595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Spinal cord stimulation (SCS) is a surgical technique used in patients with chronic intractable pain, and its effectiveness and safety have been validated by multiple studies. However, to maintain an optimal and steady long-term effect is still challenging. Here, we report a new management paradigm integrating smartphone application and remote programming. Chronic pain patients with SCS implants can monitor their pain status on the phone and change stimulation parameters accordingly. The PreMaSy study is a randomized controlled trial to evaluate the clinical effectiveness and safety of this precise management system. METHODS Patients with chronic intractable pain will be screened for eligibility, and 82 participants are anticipated to be enrolled in this trial. After the electrode implantation, the stimulation effectiveness will be tested. Participants with a reduction of more than 50% in the visual analog scale (VAS) will receive implantation of an implantable pulse generator and randomized (1:1) into the experimental group or control group. All participants will be asked to take online follow-ups and complete assessments using a smartphone application. Daily pain characteristic assessments and monthly quality of life questionnaires are integrated into the App, and participants will be required to complete these assessments. The daily VAS for pain intensity will be monitored and a threshold will be set based on baseline VAS score. The interventional appointment will be scheduled once the threshold is reached. The primary outcome is the health condition and quality of life assessed by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). Utility values of EQ-5D-5L will be assessed at baseline and 1, 3, and 6 months post-operative. DISCUSSION The PreMaSy study aims to evaluate the effectiveness and safety of a novel App-based, patient-centered, self-assessment management system for chronic intractable pain. A randomized controlled trial is designed to test the non-inferiority of this precise management system compared to the monthly online follow-ups. It is also expected to yield valuable experiences regarding precision medicine. TRIAL REGISTRATION ClinicalTrials.gov NCT05761392. Registered on March 07, 2023.
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Affiliation(s)
| | - Duo Xie
- Air Force Medical Center PLA, Beijing, China
| | - Yan Han
- Department of Neurology Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Siying Guo
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenxing Sun
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Linkai Jing
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Weitao Man
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Dongkang Liu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Kaiyuan Yang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Dan Lei
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhe Meng
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guoqin Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Weiwei Wu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Yang Lu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
- Institute for Precision Medicine, Tsinghua University, Beijing, China.
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7
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Yang S, Zhong S, Fan Y, Zhu Y, Xu N, Liao Y, Fan G, Liao X, He S. Research hotspots and trends on spinal cord stimulation for pain treatment: a two-decade bibliometric analysis. Front Neurosci 2023; 17:1158712. [PMID: 37304039 PMCID: PMC10248081 DOI: 10.3389/fnins.2023.1158712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background Chronic pain poses a significant social burden. Spinal cord stimulation (SCS) is considered to be the most promising treatment for refractory pain. The aim of this study was to summarize the current research hotspots on SCS for pain treatment during the past two decades and to predict the future research trends by bibliometric analysis. Methods The literature over the last two decades (2002-2022) which was related to SCS in pain treatment was obtained from the Web of Science Core Collection. Bibliometric analyses were conducted based on the following aspects: (1) Annual publication and citation trends; (2) Annual publication changes of different publication types; (3) Publications and citations/co-citations of different country/institution/journal/author; (4) Citations/co-citation and citation burst analysis of different literature; and (5) Co-occurrence, cluster, thematic map, trend topics, and citation burst analysis of different keywords. (6) Comparison between the United States and Europe. All analyses were performed on CiteSpace, VOSviewer, and R bibliometrix package. Results A total of 1,392 articles were included in this study, with an increasing number of publications and citations year by year. The most highly published type of literature was clinical trial. United States was the country with the most publications and citations; Johns Hopkins University was the institution with the most publications; NEUROMODULATION published the most papers; the most published author was Linderoth B; and the most cited paper was published in the PAIN by Kumar K in 2007. The most frequently occurring keywords were "spinal cord stimulation," "neuropathic pain," and "chronic pain," etc. Conclusion The positive effect of SCS on pain treatment has continued to arouse the enthusiasm of researchers in this field. Future research should focus on the development of new technologies, innovative applications, and clinical trials for SCS. This study might facilitate researchers to comprehensively understand the overall perspective, research hotspots, and future development trends in this field, as well as seek collaboration with other researchers.
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Affiliation(s)
- Sheng Yang
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sen Zhong
- Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunshan Fan
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanjie Zhu
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ningze Xu
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yue Liao
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoxin Fan
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical school, Shenzhen, China
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang Liao
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical school, Shenzhen, China
| | - Shisheng He
- Department of Orthopedic, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Rauck RL, Loudermilk E, Thomson SJ, Paz-Solis JF, Bojrab L, Noles J, Vesper J, Atallah J, Roth D, Hegarty J, Prud'Homme M, Phillips GM, Smith SG, Ibrahim M, Willoughby CD, Obray JB, Gupta M, Paez J, Berg AP, Harrison NJ, Maino P, Mambalam P, McCarty M, Towlerton G, Love-Jones S, Ahmed S, Lee A, Shah B, Goor-Aryeh I, Russo MA, Varela N, Phelps JB, Cid J, Fernandez T, Pérez-Hernández C, Keehn D, Rosenow JM, Haider N, Parrent AG, Lawrence MM, Georgius P, Demartini L, Mendiola A, Mehta V, Thoma R, Israel AF, Carolis GD, Bhatia S, Green M, Villarreal A, Crooks MT, Gwinn RP, Pilitsis JG, Sato H, Vega SM, Hillegass MG, Carnes P, Scherer C, Brill S, Yu J, Brennan JJ, Gatzinsky K, Navani A, Snook LT, Bujedo BM, Andrés Ares JD, Murillo A, Trobridge AT, Assil K, Shah J, McLeod C, Buwembo J, Coster OD, Miller N, Sanapati M, Mikhael M, Przkora R, Sukenaga N, Raso LJ, Calodney AK, Cáceres Jerez LE, Uchiyama T, Kallewaard JW, Chandler B, Piedimonte F, Candido KD, Weaver TE, Agari T, Holthouse D, Woon R, Patel N, Lechleiter K, Jain R. Long-term safety of spinal cord stimulation systems in a prospective, global registry of patients with chronic pain. Pain Manag 2023; 13:115-127. [PMID: 36691862 DOI: 10.2217/pmt-2022-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: The availability of long-term (>2 years) safety outcomes of spinal cord stimulation (SCS) remains limited. We evaluated safety in a global SCS registry for chronic pain. Methods: Participants were prospectively enrolled globally at 79 implanting centers and followed out to 3 years after device implantation. Results: Of 1881 participants enrolled, 1289 received a permanent SCS implant (1776 completed trial). The annualized rate of device explant was 3.5% (all causes), and 1.1% due to inadequate pain relief. Total incidence of device explantation >3 years was 7.6% (n = 98). Of these, 32 subjects (2.5%) indicated inadequate pain relief as cause for removal. Implant site infection (11 events) was the most common device-related serious adverse event (<1%). Conclusion: This prospective, global, real-world study demonstrates a high-level of safety for SCS with low rate of explant/serious adverse events. Clinical Trial Registration: NCT01719055 (ClinicalTrials.gov).
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Affiliation(s)
- Richard L Rauck
- Carolinas Pain Institute & The Center for Clinical Research LLC, Winston-Salem, NC 27103, USA
| | | | - Simon J Thomson
- Mid & South Essex University Hospitals, Basildon, Essex, SS16 5NL, United Kingdom
| | | | - Louis Bojrab
- Forest Health Medical Center, Ypsilanti, MI 48198, USA
| | - John Noles
- Spine & Pain Specialists, Shreveport, LA 71105, USA
| | - Jan Vesper
- University Hospital Düsseldorf, Düsseldorf, 40225, Germany
| | | | - Daniel Roth
- Summit Pain Management, Fort Wayne, IN 46804, USA
| | - Joseph Hegarty
- Optim Health System - Tattnall Hospital, Reidsville, GA 30453, USA
| | | | | | - Stephen G Smith
- Ramos Center for Interventional & Functional Pain Medicine, Englewood, FL 34205, USA
| | - Mohab Ibrahim
- University of Arizona, Banner Health - University Medical Center, Tucson, AZ 85719, USA
| | | | - Jon B Obray
- Southwest Spine & Pain Center, St George, UT 84790, USA
| | - Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, LLC, Overland Park, KS 66210, USA
| | - Julio Paez
- Southlake Pain Institute, Clermont, FL 34711, USA
| | | | | | - Paolo Maino
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, 6900, Switzerland
| | | | | | - Glyn Towlerton
- Chelsea & Westminster Hospitals, London, SW10 9NH, United Kingdom
| | | | - Shakil Ahmed
- Weill Cornell Medicine, Center for Comprehensive Spine Care, New York City, NY 10022, USA
| | - Albert Lee
- Tallahassee Neurological Clinic, Tallahassee, FL 32308, USA
| | - Binit Shah
- Carolinas Pain Center, Charlotte, NC 28262, USA
| | - Itay Goor-Aryeh
- Pain Medicine Institute, Sheba Medical Center, Ramat Gan, 52621, Israel
| | - Marc A Russo
- Hunter Pain Specialists, Broadmeadow, New South Wales, 2292, Australia
| | | | | | - José Cid
- Toledo University Hospital Complex, Toledo, 45004, Spain
| | - Tacson Fernandez
- Royal National Orthopaedic Hospital, NHS Trust, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | | | - Douglas Keehn
- Pain Centers of Wisconsin, Fort Atkinson, WI 53220, USA
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nameer Haider
- APMR Spinal & Skeletal Pain Medicine, Utica, NY 13502, USA
| | - Andrew G Parrent
- London Health Sciences Centre, Western University, London, ON, N6A 5W9, Canada
| | | | - Peter Georgius
- Sunshine Coast Clinical Research, Noosa Heads, Queensland, 4567, Australia
| | | | - Agustin Mendiola
- Puerta de Hierro University Hospital, Boadilla del Monte, 28222, Spain
| | - Vivek Mehta
- St. Bartholomew's Hospital, London, EC1A 7BE, United Kingdom
| | | | - Atef F Israel
- Pain Management Associates, Lee's Summit, MO 64086, USA
| | | | - Sanjay Bhatia
- West Virginia University Neurosurgery, Morgantown, WV 26506, USA
| | - Matthew Green
- Pain Medicine of South Australia, Wayville, South Australia, 5034, Australia
| | | | | | - Ryder P Gwinn
- EvergreenHealth Neurosurgery, Kirkland, WA 98034, USA
| | - Julie G Pilitsis
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Hitoaki Sato
- Kobe University Hospital, Kobe City, Hyōgo, 650-0017, Japan
| | | | | | - Paul Carnes
- Raleigh Neurology Associates, Raleigh NC 27607, USA
| | | | - Silviu Brill
- Sourasky Medical Center, Tel Aviv, 6423914, Israel
| | - James Yu
- Sydney Spine & Pain, Hurstville, NSW, 2220, Australia
| | - James J Brennan
- Sentara Neurosurgery Specialists, Virginia Beach, VA 23454, USA
| | | | - Annu Navani
- Comprehensive Spine & Sports Center, Campbell, CA 95008, USA
| | - Lee T Snook
- Metropolitan Pain Management Consultants, Sacramento, CA 95821, USA
| | | | | | - Abel Murillo
- AMPM Research Clinic, Miami Gardens, FL 33169, USA
| | | | - Kamyar Assil
- Conejo Pain Specialists Medical Group, Thousand Oaks, CA 91360, USA
| | - Jawad Shah
- Insight Neurosurgery, Dearborn Heights, MI 48091, USA
| | - Carroll McLeod
- Mississippi Sports Medicine & Orthopaedic Center, Jackson, MS 39110, USA
| | - Joseph Buwembo
- University of Saskatchewan College of Medicine, Saskatoon, SK, S7N 5E5, Canada
| | | | - Nathan Miller
- Coastal Pain & Spinal Diagnostics, Carlsbad, CA 92009, USA
| | | | | | - Rene Przkora
- University of Florida Health, Gainesville, FL 32610, USA
| | - Norihiko Sukenaga
- Hyōgo College of Medicine Hospital, Nishinomiya, Hyōgo, 663-8501, Japan
| | | | | | | | - Takuya Uchiyama
- Kindai University, Faculty of Medicine, Osaka-sayama, Osaka, 577-8502, Japan
| | | | | | | | | | - Tristan E Weaver
- The Ohio State University Medical Center, Columbus, OH 43210, USA
| | - Takashi Agari
- Tokyo Metropolitan Neurological Hospital, Tokyo, 150-0013, Japan
| | - David Holthouse
- Green Lizard Science, Claremont, Western Australia, 6010, Australia
| | - Rex Woon
- Boston Scientific Neuromodulation, Valencia, CA 91355, USA
| | | | | | - Roshini Jain
- Boston Scientific Neuromodulation, Valencia, CA 91355, USA
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9
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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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10
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Rigoard P, Ounajim A, Goudman L, Banor T, Héroux F, Roulaud M, Babin E, Bouche B, Page P, Lorgeoux B, Baron S, Adjali N, Nivole K, Many M, Charrier E, Rannou D, Poupin L, Wood C, David R, Moens M, Billot M. The Challenge of Converting "Failed Spinal Cord Stimulation Syndrome" Back to Clinical Success, Using SCS Reprogramming as Salvage Therapy, through Neurostimulation Adapters Combined with 3D-Computerized Pain Mapping Assessment: A Real Life Retrospective Study. J Clin Med 2022; 11:272. [PMID: 35012013 PMCID: PMC8746025 DOI: 10.3390/jcm11010272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022] Open
Abstract
While paresthesia-based Spinal Cord Stimulation (SCS) has been proven effective as treatment for chronic neuropathic pain, its initial benefits may lead to the development of "Failed SCS Syndrome' (FSCSS) defined as decrease over time related to Loss of Efficacy (LoE) with or without Loss of Coverage (LoC). Development of technologies associating new paresthesia-free stimulation waveforms and implanted pulse generator adapters provide opportunities to manage patients with LoE. The main goal of our study was to investigate salvage procedures, through neurostimulation adapters, in patients already implanted with SCS and experiencing LoE. We retrospectively analyzed a cohort of patients who were offered new SCS programs/waveforms through an implanted adapter between 2018 and 2021. Patients were evaluated before and at 1-, 3-, 6- and 12-month follow-ups. Outcomes included pain intensity rating with a Visual Analog Scale (VAS), pain/coverage mappings and stimulation preferences. Last follow-up evaluations (N = 27) showed significant improvement in VAS (p = 0.0001), ODI (p = 0.021) and quality of life (p = 0.023). In the 11/27 patients with LoC, SCS efficacy on pain intensity (36.89%) was accompanied via paresthesia coverage recovery (55.57%) and pain surface decrease (47.01%). At 12-month follow-up, 81.3% preferred to keep tonic stimulation in their waveform portfolio. SCS conversion using adapters appears promising as a salvage solution, with an emphasis on paresthesia recapturing enabled via spatial retargeting. In light of these results, adapters could be integrated in SCS rescue algorithms or should be considered in SCS rescue.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France; (T.B.); (P.P.)
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
- Laboratoire de Mathématiques et Applications, UMR 7348, Poitiers University and CNRS, 86000 Poitiers, France
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Tania Banor
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France; (T.B.); (P.P.)
| | - France Héroux
- Department of Neurosurgery, Sherbrooke University, Saguenay Delocalized Site, Chicoutimi Hospital, Sherbrooke, QC G7H 5H6, Canada;
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
| | - Etienne Babin
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
- Laboratoire de Mathématiques et Applications, UMR 7348, Poitiers University and CNRS, 86000 Poitiers, France
| | - Bénédicte Bouche
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France; (T.B.); (P.P.)
| | - Philippe Page
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France; (T.B.); (P.P.)
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
| | - Nihel Adjali
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
| | - Elodie Charrier
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Delphine Rannou
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Laure Poupin
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Chantal Wood
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France; (T.B.); (P.P.)
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (M.R.); (E.B.); (B.B.); (B.L.); (S.B.); (N.A.); (K.N.); (M.M.); (C.W.); (R.D.)
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