Neuromodulation : journal of the International Neuromodulation Society
-
Review Case Reports
Cervical Spinal Cord Stimulation for Treatment of Sympathetically Mediated Orofacial Pain: Case Series and Narrative Review.
Sympathetically mediated orofacial pain is a rare form of craniofacial pain that may be refractory to conventional medical management. We report two cases of orofacial pain with sympathetic features treated with cervical spinal cord stimulation (SCS) using burst waveform with passive recharge. In addition, we present a narrative review of cervical SCS use in the management of orofacial pain. ⋯ Cervical SCS is a viable therapeutic option for patients with orofacial pain syndromes including those with sympathetic features, although further randomized clinical studies are warranted that should include a comprehensive set of outcomes measuring pain intensity, physical function, emotional function, quality of life, and general well-being.
-
Review Case Reports
Psychophysical and Functional Outcomes in Chemotherapy-induced Peripheral Neuropathy After Spinal Cord Stimulation: A Narrative Review and Case Series.
Chemotherapy-induced peripheral neuropathy (CIPN) is a complication that may occur after treatment with various anticancer drugs. In refractory CIPN cases, spinal cord stimulation (SCS) has garnered increased attention. The use of gait analysis and psychophysical quantitative sensory testing (QST) as an objective measurement of CIPN-related damage has burgeoned; however, these changes have not been reported for patients with CIPN after SCS implantation using either burst or tonic stimulation. ⋯ We emphasize the use of different SCS waveforms as a therapy for CIPN management and the use of psychophysical testing as a measure for diagnosis and monitoring CIPN's progress in our case series and review.
-
Comparative Study
Ten-kHz Spinal Cord Stimulation vs Radiofrequency Ablation of Splanchnic Nerves: A Single-Site Retrospective Comparison of 12-Month Outcomes.
A prospective study on 10-kHz spinal cord stimulation (SCS) for various causes of chronic abdominal pain (CAP) showed robust improvements in subjects' pain and function. Radiofrequency ablation of splanchnic nerves (snRFA) has been used in advanced pain management treatment algorithms for CAP. This analysis was designed to provide what we believe is the first comparison of the efficacy of these two therapies. Propensity-score matched analysis (PMA) was performed to compare pain relief and decrease in medication usage in snRFA and SCS for treating refractory CAP. ⋯ SCS provided longer pain relief than did snRFA in this propensity-matched study. Pain scores and opioid usage were significantly less at 12-month follow-up when SCS was used for control of CAP.
-
Spinal cord stimulation (SCS) has been challenged by the lack of neurophysiologic data to guide therapy optimization. Current SCS programming by trial-and-error results in suboptimal and variable therapeutic effects. A novel system with a physiologic closed-loop feedback mechanism using evoked-compound action potentials enables the optimization of physiologic neural dose by consistently and accurately activating spinal cord fibers. We aimed to identify neurophysiologic dose metrics and their ranges that resulted in clinically meaningful treatment responses. ⋯ For the first time, an evidence-based neural dose regimen is available for a neurostimulation intervention as a starting point to enable optimization of clinical benefit, monitoring of adherence, and management of the therapy.
-
Observational Study
A Prospective Single-center Pilot Study on the Use of Closed-loop Spinal Cord Stimulation to Treat Chronic Pain Associated With Raynaud's Phenomenon.
Raynaud's phenomenon (RP) is a vascular disorder characterized by episodic peripheral artery vasospasms, resulting in paleness, cyanosis, and/or erythema. There are few reports, mostly case reports, on the benefits of spinal cord stimulation (SCS) for the treatment of RP. However, there is a lack of objective evidence on SCS-induced modulation of the sympathetic system (eg, vasodilation) in this condition. We hypothesize that evoked compound action potential-controlled closed-loop SCS may relieve pain, reduce the severity and frequency of Raynaud attacks, and improve peripheral blood flow. ⋯ This pilot study offers evidence linking SCS with the activation of large, myelinated fibers within the dorsal column in patients with RP. This activation is associated with improvement in the number of patient-related outcomes and enhanced peripheral circulation.