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Neuromodulation. 2017 Jan;20(1):71-80. doi: 10.1111/ner.12529. Epub 2016 Oct 24.

Altering Conventional to High Density Spinal Cord Stimulation: An Energy Dose-Response Relationship in Neuropathic Pain Therapy.

Author information

1
Department of Anesthesiology-Pain Medicine, Diakonessenhuis Zeist, Zeist, The Netherlands.
2
Department of Anesthesiology-Pain Medicine, Academic Medical Center (AMC) Amsterdam, Amsterdam, The Netherlands.
3
Division Clinical Methods and Public Health, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Faculty of Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands.

Abstract

OBJECTIVES:

To examine whether converting from conventional Spinal Cord Stimulation (SCS) to High Density (HD) SCS reduces neuropathic pain over a period of 12 months in patients with failed SCS therapy.

METHODS:

Retrospective, open label, single center, consecutive case series of 30 neuropathic pain patients (Failed Back Surgery Syndrome [FBSS], Complex Regional Pain Syndrome [CRPS], and polyneuropathy [NP]). Patients with an initial adequate response to conventional SCS, but in whom pain increased over time, were included (Numeric Rating Scales [NRS] >6). These patients were stimulated with HD-SCS parameters and followed-up for 12 months. We report pain intensity, measured with NRS, before SCS implantation, 1 and 3 months after starting SCS with conventional stimulation, and after 1, 6, and 12 months of HD SCS.

RESULTS:

Pain reduction with conventional stimulation was initially adequate (NRS mean 8.6 to 5.3 at three months postimplant) but increased over time to a mean NRS of 7.7 at the time of reprogramming. NRS scores decreased significantly to 4.3 (p = 0.015) after reprogramming from conventional SCS (30 Hz, 300 µsec, 3.0 V) to HD SCS (409 Hz, range 130-1000 Hz, 409 µsec, 2.4V) in the patients still using HD-SCS at 12 months. In the nonresponders (patients who stopped HD-SCS for any reason), 76% had a diagnosis of FBSS. Almost half of the patients aborting HD-SCS preferred to feel paresthesias despite better pain relief. There was a significant difference between nonresponders and responders regarding the amount of electrical energy delivered to the spinal cord.

CONCLUSION:

Neuropathic pain suppression is significantly enhanced after converting from failed conventional SCS to HD SCS in patients with FBSS, CRPS, and NP over a measured period of 12 months. There appears to be a dose-related response between the amount of energy delivered to the spinal cord and clinical effect.

KEYWORDS:

Charge per second; complex regional pain syndrome; failed back surgery syndrome; high density; invasive pain management; neuromodulation; pulse density

PMID:
27778413
DOI:
10.1111/ner.12529
[Indexed for MEDLINE]

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