Is Spinal Cord Stimulation an Effective Treatment Option for Discogenic Pain?

Introduction: In a prospective observational study conducted in an urban pain management center, we evaluated whether spinal cord stimulation (SCS) is effective in relieving discogenic pain of IDD origin. Methods: Thirteen patients with intractable discogenic low back pain were enrolled. Four patients never underwent permanent implantation due to insurance denial, medical reasons or failed trial and served as a control group. Nine patients underwent SCS implantation (treatment group). All patients were followed for 12 months and assessed at each interval for pain (NRS), disability (ODI), and opioid use. Results: Nine patients completed the SCS trial with > 50% pain relief. The pretrial NRS score was 7.8 ± 0.5 mm in treated patients vs. 6.5 ± 1.7 mm in control patients. At 3, 6 and 12 months, the NRS was reduced to 2.9 ± 0.7 mm, 1.7 ± 0.5 mm, and 2.9 ± 0.5 mm, respectively in treated patients. NRS was unchanged in the control patients (6.5 ± 1.9 mm). The ODI score prior to the SCS trial in treated patients was 53.1 ± 3.4% vs. 54.0 ± 20.5 in control patients. At 3, 6 and 12 months the ODI scores were 39.0 ± 8.0%, 38.7 ± 4.6%, and 41.1 ± 3.9%, respectively in the treated patients, and 48.5 ± 29.5 at 12 months in control patients. In 6 patients receiving opioids prior to the SCS trial, average consumption was reduced by 69% (P = 0.036) over 12 months of therapy as compared with a 54% increase in the control patients. SCS usage was stable over the 12‐month study. Conclusions: The current study indicates that SCS may provide effective pain relief, improve disability, and reduce opioid usage in patients with discogenic pain.     

A prospective study of BurstDR™ spinal cord stimulation for non-operated discogenic low back pain

Introduction

Chronic discogenic low back pain (CD-LBP) is caused by degeneration of the disc due to trauma to the annulus or by unprovoked degeneration, resulting in chronic pain. Spinal cord stimulation (SCS) employing the BurstDR™ waveform has been shown to be an effective treatment in a variety of chronic pain conditions. The aim of this prospective case study was to determine the effect of BurstDR™ SCS on pain relief, disability, and patient satisfaction in a population with CD-LBP.

Methods

Seventeen subjects with CD-LBP received a SCS trial with BurstDR™ stimulation. Patients with >50% pain relief after a trial period of 2 weeks were permanently implanted (n = 15). Patients then rated LBP and leg pain using the numeric rating scale (NRS), Oswestry disability index (ODI), patient global impression of change (PGIC), EQ-5D quality of life, and painDETECT for neuropathic pain at baseline following trial, 3, 6, and 12 months after permanent implantation.

Results

Treatment with BurstDR™ SCS resulted in significant reduction of LBP as the NRS was reduced from 71.7 ± 7.3 at baseline to 42.5 ± 18.1 at 12 months. Average pain relief at 12 months was 42.5%. In patients with leg pain (n = 8), pain was significantly reduced from 66.9 ± 8.2 to 11.7 ± 10.4 at 12 months. PainDETECT scores for neuropathic pain significantly reduced from 18.9 ± 4.8 at baseline, and 14.8 ± 3.2 at 12 months. Baseline ODI score significantly reduced from 41.2 ± 12.8 to 25.8 ± 8.6 at 12 months. PGIC scores remained low from 2.6 ± 1.6 at 3 months, 2.5 ± 1.0 at 6 months, and 2.5 ± 1.3 at 12 months. EQ-5D-5L rates remained constant from baseline 56.10 ± 23.9 to 68.6 ± 12.9 at 12 months.

Conclusion

BurstDR™ SCS resulted in significant reduction of back pain, leg pain, and quality of life in patients with CD-LBP and decreased the level of disability and generated positive patient satisfaction scores.     

Safety and Efficacy of Percutaneous Neuromodulation Therapy in the Management of Subacute Radiating Low Back Pain

Objective: Percutaneous neuromodulation therapy (PNT) is a new minimally invasive, office‐based treatment for low back pain in which electrical stimulation is delivered to the paraspinal peripheral nerves. The purpose of this study was to determine the safety, tolerability, and clinical efficacy of PNT in a population of patients with subacute low back pain with radiation to the lower extremity. Design: Open label prospective clinical trial. Setting: Multi‐center outpatient setting. Participants: We enrolled 83 patients who had radiating low back pain for 4 weeks to 6 months with a pain intensity of at least 4 on a visual analog scale of 0–10. Interventions: Subjects were treated with PNT 1 to 2 times per week for at least 4 weeks. Based on clinical response patients were treated up to an additional 8 weeks. Main Outcome Measures: We recorded baseline visual analog scale (VAS) scores of radiating pain, low back pain, physical activity, and sleep, as well as the Oswestry Disability Questionnaire. Follow‐up assessments were performed at each session, and at 5 and 12 weeks. Patients benefiting from treatments at 12 weeks were followed‐up at 6 months. Results: Fifty‐nine patients completed the study protocol. Mean VAS scores improved as follows: leg/buttock pain decreased by 37% to 4.0 ± 2.6 from a baseline of 6.6 ± 1.7 (P < 0.001); low back pain decreased by 26% to 3.9 ± 2.4 from a baseline of 5.5 ± 2.2 (P < 0.001); activity levels improved by 38% to 3.6 ± 2.2 from a baseline of 6.0 ± 2.2 (P < 0.001); and sleep improved by 27% to 3.1 ± 2.5 from a baseline of 4.8 ± 3.0 (P < 0.001). The Oswestry Low Back Pain Disability scores improved by 24% to 32 ± 16 from a baseline of 43 ± 15 (P < 0.001). Pain relief was sustained over a 3‐month observation period. Conclusion: For many patients with subacute radiating low back pain, PNT significantly reduced pain and self‐rated disability, and improved sleep quality and activity level. PNT is safe and generally well tolerated.     

Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: Randomised placebo-controlled trial

ObjectiveTo compare the immediate analgesic effect of transcutaneous nerve stimulation (TENS) and interferential current (IFC), with different combinations of parameters, in individuals with chronic low back pain (CLBP).Methodology280 individuals with CLBP were included in the study, both genders, randomized in 8 groups: GI2KHz/100Hz, GI2KHz/2Hz, GI4KHz/100Hz, GI4KHz/2Hz, placebo interferential group (GIP), GT100Hz, GT2Hz, and placebo TENS group (GTP). All individuals underwent a single application of TENS or IFC for 30min. The assessments were carried out prior to the intervention, as well as immediately after, with the following outcomes: pain intensity (Numeric Pain Rating Scale-NPRS), qualitative pain characteristics (McGill Pain Questionnaire-MPQ), and pressure pain threshold (PPT) by pressure algometry (PA) in 4 points of the low back region.ResultsIn the intergroup comparison of NPRS, all intervention groups showed greater pain reduction compared to GTP (p < 0.05). In the total MPQ score, the groups that obtained significant results (p < 0.05) when compared to GTP were GT100Hz and GT2Hz, while the groups GT100Hz and GI4KHz/100Hz were significant when compared to GIP. In the PA, GI4KHz/100Hz showed an increase in the PPT in all points compared to GTP and GI2KHz/100Hz.ConclusionBoth TENS and IFC presented immediate analgesic effect in CLBP, with emphasis on the interferential current of 4 KHz modulated at 100Hz.     

Clinical Applications of Neurostimulation: Forty Years Later

With the recent technological advances, neurostimulation has provided new hope for millions of patients with debilitating chronic pain conditions that respond poorly to other therapies. Outcome research demonstrated that patients with failed back surgery syndrome and complex regional pain syndromes benefit significantly from neurostimulation in pain reduction, functional capacity, and quality of life. Increasing clinical evidence supports the use of neurostimulation in post‐herpetic neuralgia, peripheral neuropathy, occipital neuralgia, and other neuropathic pain conditions. Strong clinical evidences indicate that neurostimulation offers less invasive and more effective therapies for many patients with ischemic pain caused by cardiovascular and peripheral vascular diseases. A growing body of literature supports neurostimulation for visceral pain in general and interstitial cystitis in particular. As a basic principle, patient selection for the appropriate neurostimulation modalities is essential for safe, efficacious, and cost‐effective applications of this therapy. Research with more vigorous designs is needed to establish evidence‐based applications of neuromodulation therapy in emerging indications of pain management.     

低频脉冲刺激辅助腰背肌功能锻炼对骨质疏松性腰部疼痛患者的效果观察

目的探究低频脉冲刺激辅助腰背肌功能锻炼应用于骨质疏松性腰部疼痛患者的效果。方法选取骨科125例骨质疏松性腰部疼痛患者,根据随机数字表分组。对照组62例给予腰背肌功能锻炼,观察组63例给予增加低频脉冲刺激,对比康复效果。结果干预后观察组视觉模拟疼痛(VAS)评分(2.30±0.21)分低于对照组(3.69±0.35)分,观察组日本骨科学会下腰痛评估量表(JOA)评分(23.66±3.28)分高于对照组(19.57±3.64)分;干预后观察组(月国)动脉流速、股总动脉流速低于对照组,股骨颈、股骨粗隆、Wards三角、腰椎骨密度高于对照组(P<0.05)。结论低频脉冲刺激辅助腰背肌功能锻炼对骨质疏松性腰部疼痛患者干预,可有效降低疼痛程度,提高骨密度,改善下肢血流速度。     

Effectiveness of Percutaneous Neuromodulation Therapy for Patients with Chronic and Severe Low Back Pain

Abstract : Percutaneous neuromodulation therapy (PNT) is a minimally invasive approach to the treatment of low back pain (LBP), involving electrical stimulation applied to percutaneous electrodes placed within the lumbar paraspinal tissues during 30-minute treatment sessions. This study reports the effects of PNT on a population of patients with chronic and severe levels of LBP. This study was performed in an outpatient clinical research setting. Thirty-nine patients were enrolled who had stable levels of LBP lasting at least 6 months, with enrollment LBP visual analog scale (VAS) scores of at least 5 on a scale of 10. The patients were treated with PNT 2 times per week for 4 weeks. Baseline VAS scores of LBP, physical activity, sleep, and the Oswestry Questionnaire were recorded. The final assessment was made 48 hours after the last treatment. After 4 sessions, the patients completed a "responder screen" questionnaire whereby, to continue treatment, they had to indicate both a perceived benefit and improvement in LBP and/or activity levels. Thirty-one patients completed the study protocol. Of the 18 patients (58% of 31) who passed the responder screen, 14 (78% of 18, 45% of 31) had ≥30% improvement in LBP and/or activity levels. Mean LBP scores decreased by 37% to 4.5 ± 2.2 from 7.1 ± 1.0 (P=0.0001); activity scores improved by 39% to 4.0 ± 2.1 from 6.7 ± 1.5 (P=0.0005); sleep scores improved by 40% from 6.2 ± 2.6 to 4.0 ± 2.6 (P=0.0003). Oswestry scores improved from 44 ± 12 to 33 ± 15 (P=0.002). In conclusion, for patients with chronic and severe stable levels of low back pain, PNT appears promising for pain level reduction and improvement in function.     

Percutaneous Peripheral Nerve Stimulation for the Treatment of Chronic Low Back Pain: Two Clinical Case Reports of Sustained Pain Relief

As the leading cause of disability among U.S. adults, chronic low back pain (LBP) is one of the most prevalent and challenging musculoskeletal conditions. Neuromodulation provides an opportunity to reduce or eliminate the use of opioids to treat chronic LBP, but the cost and invasiveness of existing methods have limited its broad adoption, especially earlier in the treatment continuum. The present case report details the results of a novel method of short‐term percutaneous peripheral nerve stimulation (PNS) in 2 subjects with chronic LBP. At the end of the 1‐month therapy, stimulation was discontinued and the leads were withdrawn. PNS produced clinically significant improvements in pain (62% average reduction in Brief Pain Inventory Question #5, average pain), and functional outcomes (73% reduction in disability, Oswestry Disability Index; 83% reduction in pain interference, Brief Pain Inventory). Both subjects reduced nonopioid analgesic use by 83%, on average, and the one subject taking opioids ceased using all opioids. The only adverse event was minor skin irritation caused by a topical dressing. The clinically significant improvements were sustained at least 4 months after start of therapy (79% average reduction in pain; both reported minimal disability; 100% reduction in opioids; 74% reduction nonopioids). The results reveal the utility of this novel, short‐term approach and its potential as a minimally invasive neuromodulation therapy for use earlier in the treatment continuum to produce sustained pain relief and reduce or eliminate the need for analgesic medications, including opioids, as well as more expensive and invasive surgical or therapeutic alternatives.     

Efficacy of spinal cord stimulation: 10 years of experience in a pain centre in Belgium.

Spinal cord stimulation is a minimally invasive mode of treatment in the management of certain forms of chronic pain that do not respond to conventional pain therapy. Several authors have reported encouraging findings with this technique. Over a 10-year period in a single centre, 254 patients were subjected to a trial period of spinal cord stimulation with an externalized pulse generator. Two hundred and seventeen of the patients showed satisfactory results justifying permanent implantation of a spinal cord stimulation system. In 1998, an independent physician invited 153 patients (155 pain cases), who still had the system in place and who could be contacted, for an interview. The aim of this study was to evaluate the efficacy of an implanted spinal cord stimulation system in terms of pain relief and quality of life and to assess the accuracy of the patient selection criteria. The results of this study demonstrate a high success rate as evaluated by the patients' own assessments--68% of the patients rated the result of the treatment as excellent to good after an average follow-up of almost 4 years. The resumption of work by 31% of patients who had been working before the onset of pain supports these positive findings.     

悬吊训练对慢性腰痛患者运动皮质区神经网络的影响

目的:研究悬吊训练对慢性腰痛(chronic low back pain,cLBP)患者运动皮质区神经网络的影响.方法:招募20例cLBP患者和与之年龄等特征相匹配的10例健康对照者,对cLBP患者进行2周悬吊训练干预.使用经颅磁刺激技术记录干预前后cLBP患者和健康对照组多裂肌的运动诱发电位,经过数据处理绘制脑部地形...     

Analyzing chronic low back pain: the relative contribution of pain coping strategies

Sixty-two chronic low back pain patients were administered the Coping Strategies Questionnaire (CSQ) to assess the frequency of use and perceived effectiveness of a variety of cognitive and behavioral pain coping strategies. Analysis of individual variables revealed that CSQ factors, gender, physical examination findings, and chronicity of pain had significant effects on one or more of a series of pain, psychological distress or behavioral measures. To assess the relative contribution of each of these variables hierarchical stepwise regression analyses were carried out. These analyses revealed that the Helplessness factor of the CSQ explained 50% of the variance in psychological distress (Global Severity Index of the SCL-90R), and 46% of the variance in depression (Beck Depression Inventory). Patients scoring high on this CSQ factor had significantly higher levels of psychological distress. None of the demographic or medical status variables explained a significant proportion of variance in the psychological distress measures. The Diverting Attention and Praying factor of the CSQ explained a moderate (9%), but significant amount of variance in pain report. Patients scoring high on this factor had higher scores on the McGill Pain Questionnaire. Coping strategies were not strongly related to pain behavior measures such as guarding or uptime. A consideration of pain coping strategies may allow one to design pain coping skills training interventions so as to fit the needs of the individual low back pain patient.