Management of Intractable Pain in Patients With Implanted Spinal Cord Stimulation Devices During the COVID-19 Pandemic Using a Remote and Wireless Programming System

Yang Lu, Duo Xie, Xiaolei Zhang, Sheng Dong, Huifang Zhang, Beibei Yu, Guihuai Wang, James Jin Wang, Luming Li, Yang Lu, Duo Xie, Xiaolei Zhang, Sheng Dong, Huifang Zhang, Beibei Yu, Guihuai Wang, James Jin Wang, Luming Li

Abstract

As COVID-19 rampages throughout the world and has a major impact on the healthcare system, non-emergency medical procedures have nearly come to a halt due to appropriate resource reallocation. However, pain never stops, particularly for patients with chronic intractable pain and implanted spinal cord stimulation (SCS) devices. The isolation required to fight this pandemic makes it impossible for such patients to adjust the parameters or configuration of the device on site. Although telemedicine has shown a great effect in many healthcare scenarios, there have been fewer applications of such technology focusing on the interaction with implanted devices. Here, we introduce the first remote and wireless programming system that enables healthcare providers to perform video-based real-time programming and palliative medicine for pain patients with a SCS implant. During the COVID-19 pandemic from January 23, 2020, the date of lockdown of Wuhan, to April 30, 2020, 34 sessions of remote programming were conducted with 16 patients. Thirteen of the 16 patients required programming for parameter optimization. Improvement was achieved with programming adjustment in 12 of 13 (92.3%) cases. Eleven of the 16 (68.8%) patients reported that the system was user-friendly and met their needs. Five patients complained of an unstable connection resulting from the low network speed initially, and three of these patients solved this problem. In summary, we demonstrated that a remote wireless programming system can deliver safe and effective programming operations of implantable SCS device, thereby providing palliative care of value to the most vulnerable chronic pain patients during a pandemic.

Clinical trial registration: www.clinicaltrials.gov, identifier NCT03858790.

Keywords: COVID-19; chronic intractable pain; remote programming; spinal cord stimulation; telemedicine.

Conflict of interest statement

JW and GW have received research support from Beijing PINS Medical Co., (donated SCS devices for pain). LL reports personal fees from Beijing Pins Medical Co., outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2020 Lu, Xie, Zhang, Dong, Zhang, Yu, Wang, Wang and Li.

Figures

FIGURE 1
FIGURE 1
(A) General architecture of the remote programming system. (B) Physician client illustration with the real-time video consultation (right), parameter and configuration adjustment (middle), and the patient’s medical record (left). The patient sent a WebRTC request to the signaling server, which is subsequently relayed to the physician client. If an online physician replies to the WebRTC request, a P2P connection will be established, and video stream is facilitated between the two clients.

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