Impact Of Spinal Cord Stimulation Research Articles

A meta‐analysis on the impact of spinal cord stimulation on post‐operative wound healing in patients with multiple sclerosis

AbstractSpinal cord stimulation (SCS) has emerged as a potential therapeutic tool for various chronic conditions, but its efficacy in post‐operative wound healing for multiple sclerosis (MS) patients has not been comprehensively understood. This meta‐analysis aimed to evaluate the impact of SCS on post‐operative wound healing and scar formation in MS patients. A systematic literature review identified seven studies for inclusion. We focused on wound healing as measured by the redness, edema, ecchymosis, discharge, approximation (REEDA) scale 1 week post‐operation and scar formation assessed by the Manchester Scar Scale (MSS) 3 months post‐operation. The results demonstrated a significant improvement in wound healing in the SCS group, with a standard mean difference (SMD) of −5.82 (95% confidence interval [CI]: [−7.56, −4.09], p < 0.01) on the REEDA scale. For scar formation, the SCS group showed a notable reduction in MSS scores, with an SMD of −10.06 (95% CI: [−14.53, −5.58], p < 0.01). These findings underscore the potential of SCS as an adjunct therapy in enhancing surgical recovery in MS patients, pointing towards its broader applications in post‐operative care.

The impact of spinal cord stimulation on a chronic model of atrial fibrillation in a mini-pig experiment

Introduction: Despite the advancement interventional methods for treating atrial fibrillation, the effectiveness of catheter ablation remains poor, especially in patients with persistent and long-persistent atrial fibrillation. Thus, experts continue to explore new treatments for this arrhythmia. The issue of experimental studies investigating the association between spinal cord stimulation and atrial fibrillation is mainly attributed to the lack of optimal algorithms for spinal cord stimulation in animal experiments. Therefore, it is important to develop adequate algorithms for spinal cord stimulation in the chronic model of atrial fibrillation.Objective: To evaluate the impact of spinal cord stimulation on the model of atrial fibrillation in mini-pigs.Methods: In a series of experiments, 6 (100%) successful implantations of electrodes and pacemakers, and spinal cord stimulation electrodes were performed. The electrodes were used to stimulate the atria, creating a model of atrial fibrillation, while the spinal cord stimulation was carried out using an electrode implanted into the spinal canal. During the experiment, an electrophysiological study was performed using an implanted pacemaker. The inducibility of atrial fibrillation was assessed before and after the experiment using various spinal cord stimulation algorithms.Results: There were no complications associated with surgery or stimulation of the atria and spinal cord. Spinal stimulation had a modeling effect on the autonomic nervous system, significantly changing the average heart rate, Wenckebach point, and effective refractory period. When comparing spinal stimulation algorithms, algorithm 1 was found to significantly reduce the atrial fibrillation inducibility.Conclusion: Spinal cord stimulation had a modeling effect on the autonomic nervous system, significantly changing the average heart rate, Wenckebach point, and effective refractory period. Inducibility of atrial fibrillation decreases with changes in the spinal pacing algorithm. Received 15 September 2023. Revised 30 October 2023. Accepted 31 October 2023. Funding: The study was supported by Russian Science Foundation (project No. 22-25-00672). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.G. Filippenko, V.V. Shabanov, V.I. MurtazinData collection and analysis: A.G. Filippenko, T.U. Khalkhoghaev, V.V. BeloborodovStatistical analysis: A.G. Filippenko, V.V. ShabanovDrafting the article: A.G. Filippenko, V.V. BeloborodovCritical revision of the article: V.V. ShabanovFinal approval of the version to be published: V.V. Shabanov, A.G. Filippenko, V.V. Beloborodov, T.U. Khalkhoghaev, V.I. Murtazin

Spinal Cord Stimulation (SCS) reduces Morphine Milligram Equivalents (MME) in patients using Opioid analgesics for Chronic Non-Cancer Pain

Summary of background dataChronic Pain is a prevalent condition that affects many people in the United States. Spinal Cord Stimulation (SCS) has been documented to help reduce perceived pain; however, few studies have analyzed the impact of perceived pain on opioid consumption before and after SCS. ObjectivesThis retrospective cohort study aimed to evaluate the impact of spinal cord stimulation on opioid consumption after permanent SCS implant. MethodsThis IRB-approved retrospective single-center study investigated the opioid consumption of 26 adults at three different times: (1) Initial date of service-baseline- (2) SCS implant date, and (3) 6 months post-SCS implant date. Mean opioid consumption was calculated over the month prior and after to visit of (1), (2), and (3) to generate 3 separate month averages. Opioid consumptions were measured using Morphine Milligram Equivalents (MME). To determine the difference in MME consumption from baseline to permanent SCS implantation, we conducted a series of paired-sample t-tests. ResultsPatients' MME significantly decreased from baseline (M = 52.63, SD = 45.07) to 6-months post-SCS implantation (M = 24.64, SD = 31.97, t (25) = 4.29, p < .001). The effect of this difference was large (d = 0.84). Whereas patients’ morphine equivalents decreased from date of SCS implantation (M = 35.73, SD = 52.78) to 6-months post-SCS implantation (M = 24.64, SD = 31.97), this difference was not significant (t (25) = 1.66, p = .11) but yielded a small effect size (d = 0.34). Discussions/conclusionIn our study, patients using opioids for non-cancer pain management, SCS moderated the perception of pain neurocircuitry and noxious stimuli-manifestation, resulting in a reduced sense of pain and decreased opioid usage.

P111. Spinal cord stimulators adversely affect outcomes in deformity surgery

P111. Spinal cord stimulators adversely affect outcomes in deformity surgery

Impact of spinal cord stimulation on sick leave and disability pension in patients with chronic neuropathic pain: a real-world evidence study in Sweden.

Current research indicates that spinal cord stimulation (SCS) has a positive short-term impact on outcomes, such as quality of life, pain, and productivity in patients with chronic neuropathic pain. However, there is a need for studies on larger population samples. This study used data from Swedish national registers to analyze change and predictors of sick leave and disability pension 2 years before and after SCS treatment. Patients with SCS implanted between 2006 and 2017, and a reference group consisting of 5 individuals matched to each SCS patient without replacement with respect to age, sex, and region of residence, were included. A difference-in-difference approach was used to compare the average change (2 years after treatment vs 2 years before treatment) in net disability days and indirect cost related to disability days for the SCS group, compared with the average change for the reference group. The results showed that SCS treatment in Sweden is associated with a decrease of 21 disability days and consequent decrease in indirect cost of €4127 in working age patients. Large work loss prior to index date was also demonstrated (average 214 days before 1 year), indicating a significant burden on the patient, employers, and the society at large. The number of disability days varied considerably depending on age, sex, socioeconomic variables, and comorbidities; however, the effect of SCS seemed to have little association with patient characteristics. This economic benefit needs to be considered, as well as the clinical outcome, when evaluating the full societal value of SCS.

The Role of Spinal Cord Stimulation in Reducing Opioid Use in the Setting of Chronic Neuropathic Pain: A Systematic Review.

The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is associated with a reduction or discontinuation of opioid use postimplantation. Systematic review of literature from PubMed, Web of Science, and Ovid Medline search of "opioid" and "pain" and "spinal cord stimulator." Inclusion criteria included original research providing data on SCS preimplantation opioid dosing and 12 months postimplantation opioid dosing or that correlated specific preimplantation opioid dose or opioid dose cutoff with significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Systematic review of the literature yielded 17 studies providing data on pre-SCS and post-SCS implantation dose and 4 providing data on the preimplantation opioid dose that significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Data from included studies indicated that SCS is an effective tool in reducing opioid dose from preimplantation levels at 12 months postimplantation. Data preliminarily supports the assertion that initiation of SCS at a preimplantation opioid dose of ≤20 to ≤42.5 morphine milligram equivalents increases the likelihood of postimplantation elimination of opioid use. SCS is an effective treatment for many types of chronic pain and can reduce or eliminate chronic opioid use. Preimplantation opioid dose may impact discontinuation of opioid use postimplantation and the effectiveness of SCS in the relief of chronic pain. More research is needed to support and strengthen clinical recommendations for initiation of SCS use at lower daily opioid dose.

Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis

Adil, Syed M BS; Charalambous, Lefko T BS; Spears, Charis A BA; Kiyani, Musa MD; Hodges, Sarah E BA; Yang, Zidanyue MB; Lee, Hui-Jie PhD; Rahimpour, Shervin MD; Parente, Beth PA-C; Greene, Kathryn A MPP; McClellan, Mark MD, PhD; Lad, Shivanand P MD, PhD

Effects of Dorsal Column Spinal Cord Stimulation on Neuroinflammation: Revisiting Molecular Mechanisms and Clinical Outcomes on Chronic Lumbar/Leg Pain and Failed Back Surgery Syndrome.

ObjectiveIn this narrative review, we reviewed and discussed current literature describing the molecular mechanisms leading to neuroinflammation and its role in the onset and progression of chronic neuropathic lumbar and leg pain in patients with persistent spinal pain syndrome. In addition, we reviewed the proposed mechanisms and impact of spinal cord stimulation (SCS) on neuroinflammation.MethodsA broad search of current literature in PubMed, Embase, Scopus, Cochrane library, Medline/Ovid, and Web of Science was performed using the following terms and their combinations: “biomarkers”, “chronic back and leg pain”, “cytokines”, “neuroinflammation”, “spinal cord stimulation (scs),” and “spinal cord modulation”. We selected: 1) articles published in the English language between January 2000 and July 2020 2) preclinical and clinical data 3) case reports 4) meta-analysis and systematic reviews and 5) conference abstracts. Manuscripts not disclosing methodology or without full-text availability were excluded.DiscussionSCS techniques have gradually evolved since inception to include novel methods such as burst-SCS, high frequency SCS, and differential targeted multiplexed SCS. The incidence of chronic pain after spine surgery is highly variable, with at least one third of patients developing persistent spinal pain syndrome. Novel SCS techniques have been associated with improved clinical and functional outcomes thus increasing patient quality of life.ConclusionCurrently, health care providers rely on different options and methods for SCS when treating patients with refractory chronic lumbar pain and persistent spinal pain syndrome. Nevertheless, compelling clinical trials remain necessary to elucidate the long-term benefits and mechanisms of neuromodulation of all different types of SCS.

Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis.

Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs. To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction. The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME). A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P<.001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P<.001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P=.01). Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.

Commentary: Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis.

Commentary: Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis.

BURST(able): A Retrospective, Multicenter Study Examining the Impact of Spinal Cord Stimulation with Burst on Pain and Opioid Consumption in the Setting of Salvage Treatment and “Upgrade”

Background Loss of efficacy (LOE) is a well-known phenomenon associated with spinal cord stimulation (SCS) and is the leading cause of explant. Although recent advances in neuromodulation have resulted in a decreased incidence of LOE, it still occurs. Intuition suggests that when LOE ensues, switching to a SCS therapy/platform could potentially be a viable clinical option; however, there are no data presently available to validate this theory. Objectives The primary objective was to evaluate the efficacy of SCS rotation with DeRidder Burst on reversing LOE. A subobjective was to evaluate the hypothesis that the body will treat a novel waveform as a different therapy when introduced for the first time, regardless of the setting. Study design Multicenter, retrospective. Setting Private practice. Methods A total of 307 patients with ongoing SCS had a de novo conversion to DeRidder Burst via surgical revision or software upgrade. Each cohort was split into 2 additional arms/subcohorts: those who were failing their SCS (salvage) versus those who were reporting success with their SCS system but were looking for increased pain relief (upgrade). This study was physician-directed and not commercially funded. Results There were statistically significant reductions in Numeric Rating Scale, percent pain relief in both surgical revision and software upgrade arms. A statistical reduction in opioid dosing was seen in the overall population and the salvage group. Larger reductions in pain/opioid consumption were observed in the surgically revised group when the revision was performed earlier. Subgroup analysis showed both salvage and upgrade groups restored treatment efficacy irrespective of time or the previous frequency/waveform. Limitations The retrospective nature of the study and the inability to eliminate potential confounding variables when evaluating the use of opioids in the study population. Conclusions LOE is an unfortunate occurrence with few evidence-based solutions presently available to reverse it. Our findings suggest that implementing D-Burst stimulation may be an effective option for treating LOE, as well as potentially reducing opioid consumption, regardless of the prior SCS system.

Effects of spinal cord stimulation on heart rate variability in patients with Failed Back Surgery Syndrome.

BackgroundBuilding on the recent finding that chronic pain patients with impaired functioning of the descending nociceptive inhibitory system (DNIS) present lower resting heart rate variability (HRV), this study aims to investigate the impact of Spinal Cord Stimulation (SCS) on HRV in patients with Failed Back Surgery Syndrome (FBSS). More precisely, we hypothesize that SCS influences the DNIS, with increased parasympathetic tone as a consequence, as measurable by HRV analysis.MethodsTwenty-two patients diagnosed with FBSS and treated with SCS participated in this study. HRV was measured with a 2-lead ECG registration tool during on and off states of SCS. HRV analysis for time, frequency, time-frequency and nonlinear domain parameters was based on a 5-minute recording segment.ResultsThe mean heart rate and low frequency power were significantly lower when SCS was activated. HRV, absolute and normalized high frequency power significantly increased during SCS compared to without SCS. The ratio of low frequency/high frequency ratios, as parameter for global sympathetic-parasympathetic equilibrium, significantly decreased when SCS was activated.ConclusionsWhen SCS is switched off, patients with FBSS present relatively stronger sympathetic tone and weaker parasympathetic activity. Activation of the SCS, possibly via stimulation of the DNIS, restores this disbalance of autonomic activity.

Serum Level of Metalloproteinase-2 but not Metalloproteinase-9 Rises in Patients With Failed Back Surgery Syndrome After Spinal Cord Stimulation

The impact of spinal cord stimulation (SCS) on serum levels of metalloproteinase-2 (MMP-2) and metalloproteinase-9 (MMP-9) was assessed in a group of patients with failed back surgery syndrome (FBSS). The study was to give new insights into the SCS mechanism of action and the role of MMP-2 and MMP-9 in the development of NP. Clinical assessments were performed and biochemical markers were determined in two groups of patients: the control group (24 individuals) and the FBSS group (24 patients). Seventeen patients with the FBSS had SCS implanted and were examined before surgical procedure, one month after (17 patients), and three months after operation (12 patients). Clinical status was assessed with the use numeric rating scale, pain rating index of McGill pain questionnaire, Oswestry disability index and Beck depression inventory. MMP-2 and MMP-9 serum levels were determined using gelatin zymography. Immunoenzymatic method was employed to determine plasma concentrations of tissue inhibitors of metalloproteinases (TIMPs). Levels of MMP-2 and TIMP-2 were higher in the FBSS group compared to the control group. The difference was statistically significant (p < 0.001 and p = 0.004, respectively). The concentration of MMP-2 was significantly increased (p = 0.0135) one-month post-SCS and remained elevated but stable up to three months after implantation. TIMP-2, MMP-2/TIMP-2, MMP-9, TIMP-1, and MMP-9/TIMP-1 serum levels did not change significantly. MMPs may play a role in the development of FBSS. SCS increases the already elevated MMP-2 serum levels which are associated with neuroinflammatory processes in FBSS patients.

Spinal cord stimulation modulates descending pain inhibition and temporal summation of pricking pain in patients with neuropathic pain

Spinal cord stimulation (SCS) is an established treatment option for patients with refractory chronic pain conditions. While effects of SCS on dorsal horn neuronal circuitries are intensively studied, current knowledge on the impact of SCS on descending pain pathways is scarce and relies on preclinical data. We aimed to address this topic and hypothesized a significant effect of SCS on descending pain modulation. In light of current efforts to determine the sensitivity of "static" versus "dynamic" somatosensory parameters to characterize pathophysiological pain conditions, all SCS patients were carefully investigated using both classes of somatosensory outcome parameters. Descending pain pathways were investigated by using a "Cold Pressor Test." This test enables to evaluate the efficacy of conditioned pain modulation (CPM) at the individual level. CPM efficacy was assessed in eight neuropathic pain patients (age 55.5±10.6) during the two conditions stimulator "ON" and "OFF." The impact of SCS on "static" and "dynamic" somatosensory parameters was explored by using a quantitative sensory testing (QST) battery. CPM efficacy on pressure pain sensitivity was nearly absent during "OFF" (- 1.2±5.6% facilitation), but increased significantly to 16.3±3.4% inhibition during "ON" (p = 0.03). While most "static" nociceptive QST parameters, represented by mechanical/thermal pain thresholds, exhibited only small effects of SCS (p > 0.05), the wind-up ratio was strongly reduced to within the normal range during "ON" (p = 0.04; Cohen's d = 1.0). Dynamic mechanical allodynia was abolished in six of seven patients. Our study provides first human evidence for an impact of SCS on descending pain pathways in the dorsolateral funiculus and emphasizes the significance of "dynamic" pain measures like "CPM"-efficacy and "temporal summation" to evaluate SCS treatment effects. Future prospective studies may use these measures of nociceptive processing to predict SCS therapy response.

The Impact of Spinal Cord Stimulation on Sleep Patterns

Studies of chronic pain show sleep disturbances to be a prevalent symptom in 50-88% of patients and studies show improved pain to correspond with improved sleep. The impact of spinal cord stimulation (SCS) on sleep in failed back surgery syndrome, complex regional pain syndrome, and neuropathic pain patients has not been studied prospectively. We prospectively assess the impact of SCS on sleep quality using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). Further we examine the correlations between sleep and pain. Patients who underwent permanent SCS implantation completed six validated questionnaires to compare sleep patterns, pain intensity, and quality of life at baseline and six months postoperatively. Results were analyzed via paired samples t-tests and bivariate analysis. Data from 27 patients were collected. We saw a significant decrease in ISI scores (n = 23, t(df)=2.9(22), p = 0.008), and noted a trend in the percentage improvement between ISI and ESS (n = 12, t(df)=2.0(10), p = 0.078). We did not see any significant improvement in ESS. However, improvements in insomnia correlated with pain intensity as measured through visual analog scale score and McGill Pain Questionnaire (R = 0.546, p = 0.007 and R = 0.559, p = 0.006, respectively). We demonstrate that insomnia scores on ISI improve with SCS at six-month follow-up. Further, we find that improvements in pain correlate with these ISI improvements.

The impact of spinal cord stimulation for upper extremity complex regional pain syndrome on level of function

Background/aims Spinal cord stimulation (SCS) is able to provide significant pain relief in individuals with complex regional pain syndrome (CRPS). Less is known about how this treatment impacts on function, particularly from the patients' perspective. This qualitative exploratory study was part of a larger service evaluation into current and future management of this patient group. This evaluation aimed to gain insight into the influence of SCS on daily activity and work and to explore the patients' journey from symptoms to diagnosis, SCS implant and afterwards. Methods A purposive sample of three patients took part in semi-structured interviews. Thematic content analysis of the data was then used to extract themes and subthemes. Results Thematic content analysis identified two emerging concepts: freedom and conflict. Within these two concepts, seven subthemes were apparent. Although participants described feelings of independence due to the effect of SCS on activity levels, other less encouraging issues were identified. These include a dependence on the stimulator, a lack of control over the future, and a perceived lack of understanding of their condition by others. Conclusion How these concepts relate to patients' ability to return to work is explored and areas for further research are identified.

Spinal Cord Stimulation in Thromboangiitis Obliterans and Secondary Raynaud's-Syndrome

Introduction Spinal cord stimulation (SCS) may be a treatment option in limb ischemia occurring as a result of Thromboangiitis obliterans (TAO) or secondary Raynaud's-Syndrome (SRS). The impact of SCS on disease progression and micro-perfusion was prospectively evaluated during a follow-up (FU) of 4 years. Report Under SCS, a significant increase in trans-cutaneous oxygen tension (tcpO2) was observed in TAO and a significant increase in systolic perfusion pressure at plethysmography was observed in SRS. Complete limb preservation was achieved in all patients who had reduced tobacco consumption. Discussion SCS is an efficient therapeutic tool in TAO and SRS. Patient selection criteria are crucial for success.

The impact of spinal cord stimulation on physical function and sleep quality in individuals with failed back surgery syndrome: A systematic review

The aim of this review was to determine the impact of spinal cord stimulation (SCS) on physical function and sleep quality in individuals with failed back surgery syndrome (FBSS). This review comprised three phases: an electronic database search (PubMed, Cinahl Plus, EMBASE, PsychInfo, Pedro, Cochrane Library) identified potential papers; these were screened for inclusion criteria, with extraction of data from accepted papers and rating of internal validity by two independent reviewers using the Effective Public Health Practice Project quality assessment tool, a tool designed to assess non-RCTs (randomized controlled trials) as well as RCTs. Strength of the evidence was rated using the Agency for Health Care Policy and Research guidelines. The search generated 13 quantitative papers that fulfilled the inclusion criteria; all 13 studies investigated the impact of SCS on physical function, and nine studies investigated the impact of SCS on sleep quality. Consistent evidence (level C) found that SCS positively affected physical function, with improvements in participation in activities of daily living, leisure, social and work-related activities. Similarly, consistent evidence (level C) found improvements in sleep quality following SCS. Improvements in sleep quantity, a reduction in awakenings and a decrease in sleep medication use were also noted (level D). The impact of SCS on cognitive function, i.e., memory and concentration, was also assessed using the same search strategy, no papers fulfilled the inclusion criteria for this study. Spinal cord stimulation effectively addressed many physical function and sleep problems associated with FBSS; however, there is a need for further high-quality objective investigations to support this.

Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States

Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States

Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States

Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States