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Spinal Stimulation for Pain: Future Applications

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Neurotherapeutics

Abstract

With continuous progress and rapid technological advancement of neuromodulation it is conceivable that within next decade or so, our approach to the electrical stimulation of the spinal cord used in treatment of chronic pain will change radically. The currently used spinal cord stimulation (SCS), with its procedural invasiveness, bulky devices, simplistic stimulation paradigms, and frustrating decline in effectiveness over time will be replaced by much more refined and individually tailored modality. Better understanding of underlying mechanism of action will allow us to use SCS in a more rational way, selecting patient-specific targets and techniques that properly fit each patient with chronic pain based on pain characteristics, distribution, and cause. Based on the information available today, this article will summarize emerging applications of SCS in the treatment of pain and theorize on further developments that may be introduced in the foreseeable future. An overview of clinical and technological innovations will serve as a basis for better understanding of SCS landscape for the next several years.

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References

  1. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 1967;46:489–491.

    CAS  PubMed  Google Scholar 

  2. Kumar K, Rizvi S. Historical and present state of neuromodulation in chronic pain. Curr Pain Headache Rep 2014;18:387.

    Article  PubMed  Google Scholar 

  3. Kunnumpurath S, Srinivasagopalan R, Vadivelu N. Spinal cord stimulation: principles of past, present and future practice: a review. J Clin Monit Comput 2009;23:333–339.

    Article  PubMed  Google Scholar 

  4. Barolat G, Sharan AD. Future trends in spinal cord stimulation. Neurol Res 2000;22:279–284.

    CAS  PubMed  Google Scholar 

  5. Deer TR. Current and future trends in spinal cord stimulation for chronic pain. Curr Pain Headache Rep 2001;5:503–509.

    Article  CAS  PubMed  Google Scholar 

  6. Lihua P, Su M, Zejun Z, Ke W, Bennett MI. Spinal cord stimulation for cancer-related pain in adults. Cochrane Database Syst Rev 2013;2:CD009389.

    PubMed  Google Scholar 

  7. Rigoard P, Delmotte A, D'Houtaud S, et al. Back pain: a real target for spinal cord stimulation? Neurosurgery. 2012;70:574–584.

    Article  PubMed  Google Scholar 

  8. Wolter T, Kiemen A, Kaube H. High cervical spinal cord stimulation for chronic cluster headache. Cephalalgia 2011;31:1170–1180.

    Article  PubMed  Google Scholar 

  9. Shechter R, Yang F, Xu Q, et al. Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain. Anesthesiology 2013;119:422–432.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Tiede J, Brown L, Gekht G, Vallejo R, Yearwood T, Morgan D. Novel spinal cord stimulation parameters in patients with predominant back pain. Neuromodulation 2013;16:370–375.

    Article  PubMed  Google Scholar 

  11. Van Buyten JP, Al-Kaisy A, Smet I, Palmisani S, Smith T. High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation 2013;16:59–66.

    Article  PubMed  Google Scholar 

  12. Al-Kaisy A, Van Buyten JP, Smet I, Palmisani S, Pang D, Smith T. Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med 2014;15:347–345.

    Article  PubMed  Google Scholar 

  13. Perruchoud C, Eldabe S, Batterham AM, et al. Analgesic efficacy of high-frequency spinal cord stimulation: a randomized double-blind placebo-controlled study. Neuromodulation 2013;16:363–369.

    Article  PubMed  Google Scholar 

  14. Clinicaltrials.gov. Comparison of Senza to commercial spinal cord stimulation for the treatment of chronic pain (SENZA-RCT). Available at: http://clinicaltrials.gov/ct2/show/NCT01609972). Accessed January 19, 2014.

  15. De Ridder D, Vanneste S, Plazier M, van der Loo E, Menovsky T. Burst spinal cord stimulation: toward paresthesia-free pain suppression. Neurosurgery 2010;66:986–990.

    Article  PubMed  Google Scholar 

  16. Plazier M, van der Loo E, Rooker S, Menovsky T, Vancamp T, De Ridder D. Burst stimulation: a new form of paresthesia free spinal cord suppression. Surg Neurol 2009;71:137–138.

    Article  Google Scholar 

  17. De Ridder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst spinal cord stimulation for limb and back pain. World Neurosurg 2013;80:642–649.

    Article  PubMed  Google Scholar 

  18. Clinicaltrials.gov. Success using neuromodulation with burst (SUNBURST™) study. Available at: http://clinicaltrials.gov/ct2/show/NCT02011893. Accessed January 19, 2014.

  19. Clinicaltrials.gov. Sub-sensory intraspinal neurostimulation therapy. Available at: http://clinicaltrials.gov/ct2/show/NCT01976598. Accessed January 19, 2014.

  20. Schultz DM, Webster L, Kosek P, Dar U, Tan Y, Sun M. Sensor-driven position-adaptive spinal cord stimulation for chronic pain. Pain Physician 2012;15:1–12.

    PubMed  Google Scholar 

  21. Clinicaltrials.gov. Prospective randomized feasibility study comparing manual vs. automatic position-adaptive spinal cord stimulation with surgical leads (RestoreSensor). Available at: http://clinicaltrials.gov/ct2/show/NCT01874899. Accessed January 19, 2014.

  22. Zuo C, Yang X, Wang Y, et al. A digital wireless system for closed-loop inhibition of nociceptive signals. J Neural Eng 2012;9:056010.

    Article  PubMed  Google Scholar 

  23. Parker JL, Karantonis DM, Single PS, et al. Electrically evoked compound action potentials recorded from the sheep spinal cord. Neuromodulation 2013;16:295–303.

    Article  PubMed  Google Scholar 

  24. Parker JL, Karantonis DM, Single PS, Obradovic M, Cousins MJ. Compound action potentials recorded in the human spinal cord during neurostimulation for pain relief. Pain 2012;153:593–601.

    Article  PubMed  Google Scholar 

  25. Hoppenstein R. Electrical stimulation of the ventral and dorsal columns of the spinal cord for relief of chronic intractable pain: preliminary report. Surg Neurol 1975;4:187–194.

    CAS  PubMed  Google Scholar 

  26. Nielson KD, Adams JE, Hosobuchi Y. Experience with dorsal column stimulation for relief of chronic intractable pain: 1968–1973. Surg Neurol 1975;4:148–152.

    CAS  PubMed  Google Scholar 

  27. Liem L, Russo M, Huygen FJ, et al. A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain. Neuromodulation 2013;16:471–482

    Article  PubMed  Google Scholar 

  28. Clinicaltrials.gov. A prospective, randomized, multi-center, controlled clinical trial to assess the safety and efficacy of the Spinal Modulation™ AXIUM™ neurostimulator system in the treatment of chronic pain (ACCURATE Trial). Available at: http://clinicaltrials.gov/ct2/show/NCT01923285. Accessed January 19, 2014.

  29. Rigoard P, Desai MJ, North RB, et al. Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study). Trials 2013;14:376.

    Article  PubMed  Google Scholar 

  30. Clinicaltrials.gov. Prospective, randomized study of multicolumn implantable lead stimulation for predominant low back pain. Available at: http://clinicaltrials.gov/ct2/show/NCT01697358. Accessed January 19, 2014.

  31. Clinicaltrials.gov. Randomized controlled double-blind cross-over trial evaluating the role of frequencies on spinal cord stimulation in the management of failed back surgery syndrome (SCS Frequency Study). Available at: http://clinicaltrials.gov/ct2/show/NCT01750229. Accessed January 19, 2014.

  32. Lipov EG, Joshi JR, Slavin KV. Hybrid neuromodulation technique: use of combined spinal cord stimulation and peripheral nerve stimulation in treatment of chronic pain in back and legs. Acta Neurochir (Wien) 2008;150:971.

    Google Scholar 

  33. Bernstein CA, Paicius RM, Barkow SH, Lempert-Cohen C. Spinal cord stimulation in conjunction with peripheral nerve field stimulation for the treatment of low back and leg pain: a case series. Neuromodulation 2008;11:116–123.

    Article  PubMed  Google Scholar 

  34. Mironer YE, Hutcheson JK, Satterthwaite JR, LaTourette PC. Prospective, two-part study of the interaction between spinal cord stimulation and peripheral nerve field stimulation in patients with low back pain: development of a new spinal-peripheral neurostimulation method. Neuromodulation 2011;14:151–155.

    Article  PubMed  Google Scholar 

  35. Navarro RM, Vercimak DC. Triangular stimulation method utilizing combination spinal cord stimulation with peripheral subcutaneous field stimulation for chronic pain patients: a retrospective study. Neuromodulation 2012;15:124–131.

    Article  PubMed  Google Scholar 

  36. Clinicaltrials.gov. SENSE (Subcutaneous and Epidural Neuromodulation System Evaluation) study for the treatment of chronic low back and leg pain. Available at: http://clinicaltrials.gov/ct2/show/NCT01990287. Accessed January 19, 2014.

  37. Guan Y. Spinal cord stimulation: neurophysiological and neurochemical mechanisms of action. Curr Pain Headache Rep 2012;16:217–225.

    Article  PubMed  Google Scholar 

  38. Lind G, Schechtmann G, Winter J, Linderoth B. Drug-enhanced spinal stimulation for pain: a new strategy. Acta Neurochir Suppl 2007;97:57–63.

    CAS  PubMed  Google Scholar 

  39. Lind G, Schechtmann G, Winter J, Meyerson BA, Linderoth B. Baclofen-enhanced spinal cord stimulation and intrathecal baclofen alone for neuropathic pain: Long-term outcome of a pilot study. Eur J Pain 2008;12:132–136.

    Article  CAS  PubMed  Google Scholar 

  40. Levy RM. Spinal cord stimulation in 2020. Neuromodulation 2013;16:93–96.

    Article  PubMed  Google Scholar 

  41. Lam CK, Rosenow JM. Patient perspectives on the efficacy and ergonomics of rechargeable spinal cord stimulators. Neuromodulation 2010;13:218–223.

    Article  PubMed  Google Scholar 

  42. Schade CM, Sasaki J, Schultz DM, Tamayo N, King G, Johanek LM. Assessment of patient preference for constant voltage and constant current spinal cord stimulation. Neuromodulation 2010;13:210–217.

    Article  PubMed  Google Scholar 

  43. Shellock FG, Audet-Griffin AJ. Evaluation of magnetic resonance imaging issues for a wirelessly powered lead used for epidural, spinal cord stimulation. Neuromodulation 2013 Aug 5 [Epub ahead of print].

  44. Ray CD. Electrical and chemical stimulation of the CNS by direct means for pain control: present and future. Clin Neurosurg 1981;28:564–588.

    CAS  PubMed  Google Scholar 

  45. Stanton-Hicks M, Panourias IG, Sakas DE, Slavin KV. The future of peripheral nerve stimulation. Prog Neurol Surg 2011;24:210–217.

    Article  PubMed  Google Scholar 

  46. Taylor RS, Taylor RJ, Van Buyten JP, Buchser E, North R, Bayliss S. The cost effectiveness of spinal cord stimulation in the treatment of pain: a systematic review of the literature. J Pain Symptom Manage 2004;27:370–378.

    Article  PubMed  Google Scholar 

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  1. Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street (MC 799), Chicago, IL, 60612, USA

    Konstantin V. Slavin

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Slavin, K.V. Spinal Stimulation for Pain: Future Applications. Neurotherapeutics 11, 535–542 (2014). https://doi.org/10.1007/s13311-014-0273-2

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