Abstract
Neuropathic pain is a rampant disease exacting a significant toll on patients, providers, and health care systems around the globe. Neuromodulation has been successfully employed to treat many indications including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), phantom limb pain (PLP), radiculopathies, and intractable pelvic pain, among many others. Recent studies have also demonstrated efficacy for cancer-related pain and chemotherapy induced neuropathy with these techniques. Spinal cord stimulation (SCS) is the most commonly employed technique and involves implantation of percutaneous or paddle leads targeting the dorsal columns of the spinal cord with the goal of disrupting the pain signals traveling to the brain. Tonic, high frequency, and burst waveforms have all been shown to reduce pain and disability in chronic pain patients. Closed-loop SCS systems that automatically adjust stimulation parameters based on feedback (such as evoked compound action potentials) are becoming increasingly used to help ease the burden placed on patients to adjust their programming to their pain and position. Additionally, dorsal root ganglion stimulation (DRGS) is a newer technique that allows for dermatomal coverage especially in patients with pain in up to two dermatomes. Regardless of the technique chosen, neuromodulation has been shown to be cost-effective and efficacious and should be given full consideration in patients with chronic pain conditions.
Highlights
Chronic pain is a rampant disease affecting large swaths of global populations
An investigation by Koetsier et al in animal models with DPN demonstrated that dorsal root ganglion stimulation (DRGS)’ effects are not related to GABA release from inhibitory neurons in the dorsal horn [79]
Neuropathic pain exacts a significant toll on patients, providers, and health care systems alike
Summary
Chronic pain is a rampant disease affecting large swaths of global populations. The 2016 Global burden of disease study found that pain-related conditions, especially low-back and neck pain, are the leading cause of disability worldwide [1]. SCS is a form of neuromodulation that targets the spinal cord with electrical impulses to treat various pain conditions It was first clinically utilized in 1967 by Shealy et al to treat chronic pain induced by metastatic lung cancer [3]. Cata et al conducted a case study of two patients with CIN refractory to medication, who completed a successful trial of SCS and proceeded to permanent implant. Charging IPGs varies based on the amount of energy consumed but in general patients should charge their devices at least once a week for about 1 h by placing a charger over skin at the battery site This process can become burdensome and sometimes painful. Either immediately or shortly after the procedure is complete, patients will meet with a companyspecific device representative to program their devices for everyday use
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