Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

Ivano Dones, Vincenzo Levi, Ivano Dones, Vincenzo Levi

Abstract

The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

Keywords: neuromodulation; neuropathic pain; spinal cord stimulation (SCS).

Conflict of interest statement

All the authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

References

    1. Torrance N., Smith B.H., Bennett M.I., Lee A.J. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J. Pain. 2006;7:281–289. doi: 10.1016/j.jpain.2005.11.008.
    1. Finnerup N.B., Otto M., McQuay H.J., Jensen T.S., Sindrup S.H. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005;118:289–305. doi: 10.1016/j.pain.2005.08.013.
    1. Lee A.W., Pilitsis J.G. Spinal cord stimulation: Indications and outcomes. Neurosurg. Focus. 2006;21:1–6. doi: 10.3171/foc.2006.21.6.6.
    1. Hoelscher C., Riley J., Wu C., Sharan A. Cost-Effectiveness Data Regarding Spinal Cord Stimulation for Low Back Pain. Spine. 2017;42(Suppl. 14):S72–S79. doi: 10.1097/BRS.0000000000002194.
    1. Slavin K.V. Spinal Stimulation for Pain: Future Applications. Neurotherapeutics. 2014;11:535–542. doi: 10.1007/s13311-014-0273-2.
    1. Melzack R., Wall P.D. Pain mechanisms: A new theory. Science. 1965;150:971–979. doi: 10.1126/science.150.3699.971.
    1. Shealy C.N., Mortimer J.T., Reswick J.B. Electrical inhibition of pain by stimulation of the dorsal columns: Preliminary clinical report. Anesth. Analg. 1967;46:489–491. doi: 10.1213/00000539-196707000-00025.
    1. Wolter T. Spinal cord stimulation for neuropathic pain: Current perspectives. J. Pain Res. 2014;7:651–663. doi: 10.2147/JPR.S37589.
    1. Barchini J., Tchachaghian S., Shamaa F., Jabbur S.J., Meyerson B.A., Song Z., Linderoth B., Saade N.E. Spinal segmental and supraspinal mechanisms underlying the pain-relieving effects of spinal cord stimulation: An experimental study in a rat model of neuropathy. Neuroscience. 2012;215:196–208. doi: 10.1016/j.neuroscience.2012.04.057.
    1. El-Khoury C., Hawwa N., Baliki M., Atweh S.F., Jabbur S.J., Saade N.E. Attenuation of neuropathic pain by segmental and supraspinal activation of the dorsal column system in awake rats. Neuroscience. 2002;112:541–553. doi: 10.1016/S0306-4522(02)00111-2.
    1. Rasche D., Siebert S., Stippich C., Kress B., Nennig E., Sartor K., Tronnier V.M. Spinal cord stimulation in Failed-Back-Surgery-Syndrome. Preliminary study for the evaluation of therapy by functional magnetic resonance imaging (fMRI) Schmerz. 2005;19:497–500, 502–505. doi: 10.1007/s00482-005-0388-9.
    1. Sato K.L., King E.W., Johanek L.M., Sluka K.A. Spinal cord stimulation reduces hypersensitivity through activation of opioid receptors in a frequency-dependent manner. Eur. J. Pain. 2013;17:551–561. doi: 10.1002/j.1532-2149.2012.00220.x.
    1. Yakhnitsa V., Linderoth B., Meyerson B.A. Spinal cord stimulation attenuates dorsal horn neuronal hyperexcitability in a rat model of mononeuropathy. Pain. 1999;79:223–233. doi: 10.1016/S0304-3959(98)00169-9.
    1. Foreman R.D., Linderoth B. Neural mechanisms of spinal cord stimulation. Int. Rev. Neurobiol. 2012;107:87–119. doi: 10.1016/B978-0-12-404706-8.00006-1.
    1. Schechtmann G., Song Z., Ultenius C., Meyerson B.A., Linderoth B. Cholinergic mechanisms involved in the pain relieving effect of spinal cord stimulation in a model of neuropathy. Pain. 2008;139:136–145. doi: 10.1016/j.pain.2008.03.023.
    1. Song Z., Meyerson B.A., Linderoth B. Muscarinic receptor activation potentiates the effect of spinal cord stimulation on pain-related behavior in rats with mononeuropathy. Neurosci. Lett. 2008;436:7–12. doi: 10.1016/j.neulet.2008.02.044.
    1. Nagel S.J., Lempka S.F., Machado A.G. Percutaneous spinal cord stimulation for chronic pain: Indications and patient selection. Neurosurg. Clin. N. Am. 2014;25:723–733. doi: 10.1016/j.nec.2014.06.005.
    1. Parker S.L., Mendenhall S.K., Godil S.S., Sivasubramanian P., Cahill K., Ziewacz J., McGirt M.J. Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin. Orthop. Relat. Res. 2015;473:1988–1999. doi: 10.1007/s11999-015-4193-1.
    1. Skolasky R.L., Wegener S.T., Maggard A.M., Riley L.H. The impact of reduction of pain after lumbar spine surgery: The relationship between changes in pain and physical function and disability. Spine. 2014;39:1426–1432. doi: 10.1097/BRS.0000000000000428.
    1. Grider J.S., Manchikanti L., Carayannopoulos A., Sharma M.L., Balog C.C., Harned M.E., Grami V., Justiz R., Nouri K.H., Hayek S.M., et al. Effectiveness of Spinal Cord Stimulation in Chronic Spinal Pain: A Systematic Review. Pain Physician. 2016;19:E33–E54.
    1. Taylor R.S., Desai M.J., Rigoard P., Taylor R.J. Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: A systematic review and meta-regression analysis. Pain Pract. 2014;14:489–505. doi: 10.1111/papr.12095.
    1. Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: A 20-year literature review. J. Neurosurg. 2004;100:254–267. doi: 10.3171/spi.2004.100.3.0254.
    1. Kemler M.A., Barendse G.A., Van Kleef M., De Vet H.C., Rijks C.P., Furnee C.A., Van den Wildenberg F.A. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N. Engl. J. Med. 2000;343:618–624. doi: 10.1056/NEJM200008313430904.
    1. Deer T.R., Levy R.M., Kramer J., Poree L., Amirdelfan K., Grigsby E., Staats P., Burton A.W., Burgher A.H., Obray J., et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: A randomized comparative trial. Pain. 2017;158:669–681. doi: 10.1097/j.pain.0000000000000814.
    1. Harrison C., Epton S., Bojanic S., Green A.L., FitzGerald J.J. The Efficacy and Safety of Dorsal Root Ganglion Stimulation as a Treatment for Neuropathic Pain: A Literature Review. Neuromodulation. 2017:225–233. doi: 10.1111/ner.12685.
    1. Bennett M.I., Attal N., Backonja M.M., Baron R., Bouhassira D., Freynhagen R., Scholz J., Tolle T.R., Wittchen H.U., Jensen T.S. Using screening tools to identify neuropathic pain. Pain. 2007;127:199–203. doi: 10.1016/j.pain.2006.10.034.
    1. Krause S.J., Backonja M.M. Development of a neuropathic pain questionnaire. Clin. J. Pain. 2003;19:306–314. doi: 10.1097/00002508-200309000-00004.
    1. Portenoy R. Development and testing of a neuropathic pain screening questionnaire: ID Pain. Curr. Med. Res. Opin. 2006;22:1555–1565. doi: 10.1185/030079906X115702.
    1. Freynhagen R., Baron R., Gockel U., Tolle T.R. painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain. Curr. Med. Res. Opin. 2006;22:1911–1920. doi: 10.1185/030079906X132488.
    1. Burchiel K.J., Anderson V.C., Brown F.D., Fessler R.G., Friedman W.A., Pelofsky S., Weiner R.L., Oakley J., Shatin D. Prospective, multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine. 1996;21:2786–2794. doi: 10.1097/00007632-199612010-00015.
    1. Wolter T., Fauler I., Kieselbach K. The impact of psychological factors on outcomes for spinal cord stimulation: An analysis with long-term follow-up. Pain Physician. 2013;16:265–275.
    1. Sparkes E., Raphael J.H., Duarte R.V., LeMarchand K., Jackson C., Ashford R.L. A systematic literature review of psychological characteristics as determinants of outcome for spinal cord stimulation therapy. Pain. 2010;150:284–289. doi: 10.1016/j.pain.2010.05.001.
    1. Kumar K., Wilson J.R. Factors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate. Acta Neurochir. Suppl. 2007;97:91–99.
    1. May M.S., Banks C., Thomson S.J. A Retrospective, Long-term, Third-Party Follow-up of Patients Considered for Spinal Cord Stimulation. Neuromodulation. 2002;5:137–144. doi: 10.1046/j.1525-1403.2002.02023.x.
    1. Hoelzer B.C., Bendel M.A., Deer T.R., Eldrige J.S., Walega D.R., Wang Z., Costandi S., Azer G., Qu W., Falowski S.M., et al. Spinal Cord Stimulator Implant Infection Rates and Risk Factors: A Multicenter Retrospective Study. Neuromodulation. 2017;20:558–562. doi: 10.1111/ner.12609.
    1. Rudiger J., Thomson S. Infection rate of spinal cord stimulators after a screening trial period. A 53-month third party follow-up. Neuromodulation. 2011;14:136–141. doi: 10.1111/j.1525-1403.2010.00317.x.
    1. Colombo E.V., Mandelli C., Mortini P., Messina G., De Marco N., Donati R., Irace C., Landi A., Lavano A., Mearini M., et al. Epidural spinal cord stimulation for neuropathic pain: A neurosurgical multicentric Italian data collection and analysis. Acta Neurochir. 2015;157:711–720. doi: 10.1007/s00701-015-2352-5.
    1. Deer T.R., Lamer T.J., Pope J.E., Falowski S.M., Provenzano D.A., Slavin K., Golovac S., Arle J., Rosenow J.M., Williams K., et al. The Neurostimulation Appropriateness Consensus Committee (NACC) Safety Guidelines for the Reduction of Severe Neurological Injury. Neuromodulation. 2017;20:15–30. doi: 10.1111/ner.12564.
    1. Falowski S.M., Sharan A., McInerney J., Jacobs D., Venkatesan L., Agnesi F. Nonawake vs. Awake Placement of Spinal Cord Stimulators: A Prospective, Multicenter Study Comparing Safety and Efficacy. Neurosurgery. 2018:1–8. doi: 10.1093/neuros/nyy062.
    1. Bendersky D., Yampolsky C. Is spinal cord stimulation safe? A review of its complications. World Neurosurg. 2014;82:1359–1368. doi: 10.1016/j.wneu.2013.06.012.
    1. Levy R.M. Device complication and failure management in neuromodulation. Neuromodulation. 2013;16:495–502. doi: 10.1111/ner.12148.
    1. Eldabe S., Buchser E., Duarte R.V. Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature. Pain Med. 2016;17:325–336. doi: 10.1093/pm/pnv025.
    1. Shamji M.F., Westwick H.J., Heary R.F. Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery. Neurosurg. Focus. 2015;39:E15. doi: 10.3171/2015.7.FOCUS15260.
    1. Kinfe T.M., Quack F., Wille C., Schu S., Vesper J. Paddle versus cylindrical leads for percutaneous implantation in spinal cord stimulation for failed back surgery syndrome: A single-center trial. J. Neurol. Surg. A Cent. Eur. Neurosurg. 2014;75:467–473. doi: 10.1055/s-0034-1371517.
    1. Babu R., Hazzard M.A., Huang K.T., Ugiliweneza B., Patil C.G., Boakye M., Lad S.P. Outcomes of percutaneous and paddle lead implantation for spinal cord stimulation: A comparative analysis of complications, reoperation rates, and health-care costs. Neuromodulation. 2013;16:418–426. doi: 10.1111/ner.12065.
    1. Petraglia F.W., Farber S.H., Gramer R., Verla T., Wang F., Thomas S., Parente B., Lad S.P. The incidence of spinal cord injury in implantation of percutaneous and paddle electrodes for spinal cord stimulation. Neuromodulation. 2016;19:85–89. doi: 10.1111/ner.12370.
    1. Shechter R., Yang F., Xu Q., Cheong Y.K., He S.Q., Sdrulla A., Carteret A.F., Wacnik P.W., Dong X., Meyer R.A., et al. Conventional and kilohertz-frequency spinal cord stimulation produces intensity and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain. Anesthesiology. 2013;119:422–432. doi: 10.1097/ALN.0b013e31829bd9e2.
    1. Yearwood T.L., Hershey B., Bradley K., Lee D. Pulse width programming in spinal cord stimulation: A clinical study. Pain Physician. 2010;13:321–335.
    1. De Ridder D., Vanneste S., Plazier M., Van der Loo E., Menovsky T. Burst spinal cord stimulation: Toward paresthesia-free pain suppression. Neurosurgery. 2010;66:986–990. doi: 10.1227/01.NEU.0000368153.44883.B3.
    1. Van Havenbergh T., Vancamp T., Van Looy P., Vanneste S., De Ridder D. Spinal cord stimulation for the treatment of chronic back pain patients: 500-hz vs. 1000-hz burst stimulation. Neuromodulation. 2015;18:9–12. doi: 10.1111/ner.12252.
    1. Chakravarthy K., Kent A.R., Raza A., Xing F., Kinfe T.M. Burst Spinal Cord Stimulation: Review of Preclinical Studies and Comments on Clinical Outcomes. Neuromodulation. 2018 doi: 10.1111/ner.12756.
    1. De Ridder D., Perera S., Vanneste S. Are 10 kHz Stimulation and Burst Stimulation Fundamentally the Same? Neuromodulation. 2017;20:650–653. doi: 10.1111/ner.12614.
    1. Van Buyten J.P., Al-Kaisy A., Smet I., Palmisani S., Smith T. High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation. 2013;16:56–59. doi: 10.1111/ner.12006.
    1. Perruchoud C., Eldabe S., Batterham A.M., Madzinga G., Brookes M., Durrer A., Rosato M., Bovet N., West S., Bovy M., et al. Analgesic efficacy of high-frequency spinal cord stimulation: A randomized double-blind placebo-controlled study. Neuromodulation. 2013;16:363–369. doi: 10.1111/ner.12027.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera