Time dependent variation of stimulus requirements in spinal cord stimulation for angina pectoris

The aim of the study was to observe changes over time of the stimulation requirements in spinal cord stimulation (SCS). Of 60 patients treated with SCS, 25 patients were selected because they had neurostimulators capable of measuring impedance noninvasively, and had not experienced electrode displacement. All 25 patients had Medtronic Pisces Quad 3487A (Medtronic, Inc.) neuroelectrodes with the tip positioned in the thoracic epidural space. The accuracy of the neurostimulators impedance measuring circuit was investigated in a test circuit. The error was < 11%. Stimulus requirements and impedance were recorded at the implantation and at follow-ups during a period of 24 months. During the first month after implantation, the stimulus requirements for satisfactory effect varied between +406% and -34%. After that period, only minor deviations were observed in most patients. To optimize the pain reducing effect of the spinal cord stimulation, frequent follow-ups are recommended during the first month; later on, the follow-up intervals can be extended. No tolerance development or pain resistance developed during SCS treatment.