Article
Use of a standardized workflow for intraindividual testing of different stimulation doses in patients suffering from chronic pain and treated using spinal cord stimulation (SCS)
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Authors
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Mohammad Mehdi Hajiabadi
- Universitätsklinikum Heidelberg, Neurochirurgische Universitätsklinik, Heidelberg, Deutschland
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Rezvan Ahmadi
- Universitätsklinikum Heidelberg, Neurochirurgische Universitätsklinik, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Universitätsklinik, Heidelberg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Spinal cord stimulation (SCS) is an effective treatment modality for neuropathic pain. However, 30-40% of patients (termed non-responders) do not benefit sufficiently from SCS. To enhance the therapeutic effect in non-responders, new stimulation parameters were developed. These stimulation paradigms are based on higher currents applied to the spinal cord but can only be applied by certain SCS implants. Therefore it is essential to define predictive markers to identify potential non-responders, which could benefit from adequate implants.
Methods: N=7 patients were included in our prospective study. We implanted one or two stab electrodes for intraoperative SCS testing for a complete coverage of the affected pain area. Postoperative, two High-dose (HD) and one low-dose (LD) currents schemes (Evolve®-Workflow) were applied and tested for 7-14 days. Potential Pain relief was evaluated every three days. After all programs were applied, a final analysis was performed to decide on the permanent implantation of the SCS device. Follow-ups at four and twelve weeks were scheduled.
Results: The average duration of chronic pain in our patient cohort was 3.3 years. The F:M ratio was 5:2. On average patients had been subjected to 2.4 (2-5) lumbar spine surgeries prior to SCS testing. In N=6 (86%) patients a complete coverage of the affected pain area could be achieved intraoperatively. The median follow-up was 7.5 weeks (Range: 4-13 weeks). After the testing phase, all patients (100%) benefited from the stimulation and SCS generators were implanted. 71% of the patients did not change the chosen program in the testing phase and were fully satisfied (stable response). In the testing phase, 86% of the patients with the HD program and 16% (N=1) with the LD program felt painless.
Conclusion: Evolve®-Workflow is a practicable and safe method and helps to compare LD and HD stimulation. Altogether, the SCS response rate could be improved to 100%. Most of our patients preferred HD-stimulation. Further analysis including the application of burst and sham stimulation may further improve SCS treatment.
