A Pilot Study Comparing Algorithmic Adaptive Conventional Stimulation with High-Dose Stimulation in Chronic Pain...

Area of Science:

• Neuromodulation
• Pain Management
• Spinal Cord Stimulation

Background:

• Spinal cord stimulation (SCS) is a key treatment for chronic pain.
• Previous research indicated accelerometry-assisted programming (shuffle) is beneficial for paresthesia-based SCS.
• However, SCS programming can be time-consuming.

Purpose of the Study:

• To compare standardized high-dose (HD) subthreshold SCS programming with accelerometer-based paresthesia-induced programming (shuffle).
• To evaluate the efficacy of HD stimulation at the T9-10 interspace for chronic pain relief.

Main Methods:

• A prospective, cross-over study design was employed.
• Patients underwent 4 weeks of shuffle programming and 4 weeks of HD programming, with T9-10 contacts programmed in both arms.
• Pain, activity, and sleep were assessed using validated scales and compared to baseline.

Main Results:

• Ten out of twelve patients completed the study.
• HD stimulation at T9-10 significantly improved worst pain (P=0.03), current pain (P=0.04), and walking ability (P=0.012) compared to baseline.
• No significant differences were observed between shuffle stimulation and baseline, or between shuffle and HD stimulation.

Conclusions:

• High-dose (HD) SCS at the T9-10 interspace demonstrated superiority over algorithmic paresthesia-based programming in this pilot study.
• Paresthesia-based SCS may require additional contact stimulation and programming for optimal outcomes.
• Further research into algorithmic programming for paresthesia-based SCS is warranted.