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Improved Pain Control with Combination Spinal Cord Stimulator Therapy Utilizing Sub-perception and Traditional
Amnon A Berger1, Ivan Urits1, Jamal Hasoon1
1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Anesthesiology and Pain Medicine
|July 5, 2021
Summary
Combining sub-perception stimulation with traditional spinal cord stimulation (SCS) significantly improved pain relief in patients with chronic pain. This novel approach enhances paresthesia quality and pain control for better outcomes.
Area of Science:
- Neurology
- Pain Management
- Biomedical Engineering
Background:
- Chronic back and neck pain impact 20% of Americans, often requiring advanced treatments.
- Spinal Cord Stimulation (SCS) is a key therapy for refractory chronic pain.
- Traditional SCS uses low-frequency stimulation (40-60 Hz) to create paresthesia, overlapping painful areas.
Purpose of the Study:
- To evaluate the efficacy of superimposing sub-perception stimulation onto existing paresthesia-based SCS.
- To assess changes in pain scores and sensory perception in patients receiving combined SCS therapy.
Main Methods:
- Prospective observational trial involving patients with paresthesia-based SCS for FBSS or CRPS.
- Patients underwent implantable pulse generator (IPG) replacement enabling combined SCS therapy.
- Pain (NRS) and paresthesia characteristics were assessed via telephone survey at baseline and four weeks post-exchange.
Main Results:
- Average pain (NRS) decreased from 7.47 to 4.5 with combination therapy.
- 80% of patients reported improved paresthesia quality compared to traditional SCS.
- Improved paresthesia quality correlated with significantly better pain control.
Conclusions:
- Combined sub-perception and paresthesia-based SCS shows promise for enhanced pain relief in select patients.
- The mechanism may involve additive or synergistic effects of dual waveform stimulation.
- Further research with larger cohorts and long-term follow-up is necessary to confirm durability and elucidate mechanisms.
