scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Burst spinal cord stimulation for limb and back pain.

01 Nov 2013-World Neurosurgery (Elsevier)-Vol. 80, Iss: 5, pp 642-649
TL;DR: In contrast to tonic stimulation, burst stimulation was able to provide pain relief without the generation of paresthesias, permitting them to use a double-blinded placebo controlled approach.
About: This article is published in World Neurosurgery.The article was published on 2013-11-01. It has received 317 citations till now. The article focuses on the topics: Referred pain & Back pain.
Citations
More filters
Journal ArticleDOI
TL;DR: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neurodulation Society evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications.
Abstract: Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. Methods: The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. Results: Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated. Conclusions: Appropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.

399 citations


Cites background from "Burst spinal cord stimulation for l..."

  • ...Recent encouraging new work suggests that DRG-SCS (24,25), burst frequency (22), and kilohertzfrequency (20,21) SCS may significantly improve the chances of success....

    [...]

  • ...Burst Stimulation There are preclinical data suggesting that Aδ, Aβ, and C fibers are preferentially activated at specific current frequencies when a sinusoidal (as opposed to square-wave) electrical stimulation is applied (22,26)....

    [...]

  • ...Likewise, ongoing work on DRG stimulation (24,67,68) and burst stimulation (22,27) might define new approaches to axial back pain....

    [...]

  • ...SCS at 500 Hz delivered in “bursts” of five pulses 40 times per second is an intermediate or hybrid strategy that reportedly affords relief while minimizing paresthesia (22)....

    [...]

  • ..., who published initial results of SCS in a burst pattern (22)....

    [...]

Journal ArticleDOI
01 Nov 2013-Pain
TL;DR: Based on the available data, it is recommended not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy, and four weak recommendations can be made due to the paucity of high‐quality clinical trials.
Abstract: Neuropathic pain (NP) is often refractory to pharmacologic and noninterventional treatment. On behalf of the International Association for the Study of Pain Neuropathic Pain Special Interest Group, the authors evaluated systematic reviews, clinical trials, and existing guidelines for the interventional management of NP. Evidence is summarized and presented for neural blockade, spinal cord stimulation (SCS), intrathecal medication, and neurosurgical interventions in patients with the following peripheral and central NP conditions: herpes zoster and postherpetic neuralgia (PHN); painful diabetic and other peripheral neuropathies; spinal cord injury NP; central poststroke pain; radiculopathy and failed back surgery syndrome (FBSS); complex regional pain syndrome (CRPS); and trigeminal neuralgia and neuropathy. Due to the paucity of high-quality clinical trials, no strong recommendations can be made. Four weak recommendations based on the amount and consistency of evidence, including degree of efficacy and safety, are: 1) epidural injections for herpes zoster; 2) steroid injections for radiculopathy; 3) SCS for FBSS; and 4) SCS for CRPS type 1. Based on the available data, we recommend not to use sympathetic blocks for PHN nor radiofrequency lesions for radiculopathy. No other conclusive recommendations can be made due to the poor quality of available data. Whenever possible, these interventions should either be part of randomized clinical trials or documented in pain registries. Priorities for future research include randomized clinical trials, long-term studies, and head-to-head comparisons among different interventional and noninterventional treatments.

357 citations


Cites background from "Burst spinal cord stimulation for l..."

  • ...New stimulation parameters, such as high-frequency stimulation [136], burst stimulation [35], and anatomical sites, such as dorsal root or DRG stimulation, are being explored as potential strategies to improve the efficacy of neuromodulation at the level of the spinal cord....

    [...]

Journal ArticleDOI
TL;DR: The purpose of the multicenter, randomized, unblinded, crossover Success Using Neuromodulation with BURST (SUNBURST) study was to determine the safety and efficacy of a device delivering both traditional tonic stimulation and burst stimulation to patients with chronic pain of the trunk and/or limbs.
Abstract: Objective The purpose of the multicenter, randomized, unblinded, crossover Success Using Neuromodulation with BURST (SUNBURST) study was to determine the safety and efficacy of a device delivering both traditional tonic stimulation and burst stimulation to patients with chronic pain of the trunk and/or limbs. Methods Following a successful tonic trial, 100 subjects were randomized to receive one stimulation mode for the first 12 weeks, and then the other stimulation mode for the next 12 weeks. The primary endpoint assessed the noninferiority of the within-subject difference between tonic and burst for the mean daily overall VAS score. An intention-to-treat analysis was conducted using data at the 12- and 24-week visits. Subjects then used the stimulation mode of their choice and were followed for one year. Descriptive statistics were used analyze additional endpoints and to characterize the safety profile of the device. Results The SUNBURST study demonstrated that burst stimulation is noninferior to tonic stimulation (p < 0.001). Superiority of burst was also achieved (p < 0.017). Significantly more subjects (70.8%) preferred burst stimulation over tonic stimulation (p < 0.001). Preference was sustained through one year: 68.2% of subjects preferred burst stimulation, 23.9% of subjects preferred tonic, and 8.0% of subjects had no preference. No unanticipated adverse events were reported and the safety profile was similar to other spinal cord stimulation studies. Conclusions The SUNBURST study demonstrated that burst spinal cord stimulation is safe and effective. Burst stimulation was not only noninferior but also superior to tonic stimulation for the treatment of chronic pain. A multimodal stimulation device has advantages.

318 citations


Cites background from "Burst spinal cord stimulation for l..."

  • ...However, these early studies evaluating burst stimulation enrolled small cohorts of patients in Europe and Australia over a short period of time, and only one was a randomized, controlled trial (11)....

    [...]

Journal ArticleDOI
TL;DR: The features and clinical applications of balanced‐charge kilohertz frequency alternating currents (KHFAC) are reviewed and there is a significant increase in interest in KHFAC block, both scientifically and clinically.
Abstract: Objectives The features and clinical applications of balanced-charge kilohertz frequency alternating currents (KHFAC) are reviewed. Preclinical studies of KHFAC block have demonstrated that it can produce an extremely rapid and reversible block of nerve conduction. Recent systematic analysis and experimentation utilizing KHFAC block have resulted in a significant increase in interest in KHFAC block, both scientifically and clinically. Materials and Methods We review the history and characteristics of KHFAC block, the methods used to investigate this type of block, the experimental evaluation of block, and the electrical parameters and electrode designs needed to achieve successful block. We then analyze the existing clinical applications of high-frequency currents, comparing the early results with the known features of KHFAC block. Results Although many features of KHFAC block have been characterized, there is still much that is unknown regarding the response of neural structures to rapidly fluctuating electrical fields. The clinical reports to date do not provide sufficient information to properly evaluate the mechanisms that result in successful or unsuccessful treatment. Conclusions KHFAC nerve block has significant potential as a means of controlling nerve activity for the purpose of treating disease. However, early clinical studies in the use of high-frequency currents for the treatment of pain have not been designed to elucidate mechanisms or allow direct comparisons to preclinical data. We strongly encourage the careful reporting of the parameters utilized in these clinical studies, as well as the development of outcome measures that could illuminate the mechanisms of this modality.

203 citations

Journal ArticleDOI
TL;DR: The aim was expanding the search to new techniques and to chronic pain conditions other than neuropathic pain, and assessing the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
Abstract: Background and purpose Our aim was to update previous European Federation of Neurological Societies guidelines on neurostimulation for neuropathic pain, expanding the search to new techniques and to chronic pain conditions other than neuropathic pain, and assessing the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Methods A systematic review and meta-analysis of trials published between 2006 and December 2014 was conducted. Pain conditions included neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS) type I and post-surgical chronic back and leg pain (CBLP). Spinal cord stimulation (SCS), deep brain stimulation (DBS), epidural motor cortex stimulation (MCS), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct electrical stimulation (tDCS) of the primary motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC) were assessed. The GRADE system was used to assess quality of evidence and propose recommendations. Results The following recommendations were reached: ‘weak’ for SCS added to conventional medical management in diabetic painful neuropathy, CBLP and CRPS, for SCS versus reoperation in CBLP, for MCS in neuropathic pain, for rTMS of M1 in neuropathic pain and fibromyalgia and for tDCS of M1 in neuropathic pain; ‘inconclusive’ for DBS in neuropathic pain, rTMS and tDCS of the DLPFC, and for motor cortex tDCS in fibromyalgia and spinal cord injury pain. Conclusions Given the poor to moderate quality of evidence identified by this review, future large-scale multicentre studies of non-invasive and invasive neurostimulation are encouraged. The collection of higher quality evidence of the predictive factors for the efficacy of these techniques, such as the duration, quality and severity of pain, is also recommended.

197 citations

References
More filters
Journal ArticleDOI
19 Nov 1965-Science

7,479 citations

Journal ArticleDOI
TL;DR: Functional anatomical work has detailed an afferent neural system in primates and in humans that represents all aspects of the physiological condition of the physical body that might provide a foundation for subjective feelings, emotion and self-awareness.
Abstract: As humans, we perceive feelings from our bodies that relate our state of well-being, our energy and stress levels, our mood and disposition. How do we have these feelings? What neural processes do they represent? Recent functional anatomical work has detailed an afferent neural system in primates and in humans that represents all aspects of the physiological condition of the physical body. This system constitutes a representation of 'the material me', and might provide a foundation for subjective feelings, emotion and self-awareness.

4,673 citations


"Burst spinal cord stimulation for l..." refers background in this paper

  • ...The lateral system is triggered predominantly by the wide dynamic range neurons,firing in tonicmode and relaying in lamina I and IV-VI of the dorsal horn to the VPL and VPM nucleus of the thalamus and from there to the primary and secondary somatosensory cortex, posterior parietal area (8, 19, 27)....

    [...]

Journal Article
TL;DR: The technical details of the method are presented, allowing researchers to test, check, reproduce and validate the new method, and a solution reported here yields images of standardized current density with zero localization error.
Abstract: Scalp electric potentials (electroencephalograms) and extracranial magnetic fields (magnetoencephalograms) are due to the primary (impressed) current density distribution that arises from neuronal postsynaptic processes. A solution to the inverse problem--the computation of images of electric neuronal activity based on extracranial measurements--would provide important information on the time-course and localization of brain function. In general, there is no unique solution to this problem. In particular, an instantaneous, distributed, discrete, linear solution capable of exact localization of point sources is of great interest, since the principles of linearity and superposition would guarantee its trustworthiness as a functional imaging method, given that brain activity occurs in the form of a finite number of distributed hot spots. Despite all previous efforts, linear solutions, at best, produced images with systematic nonzero localization errors. A solution reported here yields images of standardized current density with zero localization error. The purpose of this paper is to present the technical details of the method, allowing researchers to test, check, reproduce and validate the new method.

3,085 citations


"Burst spinal cord stimulation for l..." refers methods in this paper

  • ...Standardized low-resolution brain electromagnetic tomography was used to estimate the intracerebral electrical sources that generated the scalp-recorded activity in each of the eight frequency bands (Supplementary Table 1) (25)....

    [...]

Journal ArticleDOI
15 Aug 1997-Science
TL;DR: These findings provide direct experimental evidence in humans linking frontal-lobe limbic activity with pain affect, as originally suggested by early clinical lesion studies.
Abstract: Recent evidence demonstrating multiple regions of human cerebral cortex activated by pain has prompted speculation about their individual contributions to this complex experience. To differentiate cortical areas involved in pain affect, hypnotic suggestions were used to alter selectively the unpleasantness of noxious stimuli, without changing the perceived intensity. Positron emission tomography revealed significant changes in pain-evoked activity within anterior cingulate cortex, consistent with the encoding of perceived unpleasantness, whereas primary somatosensory cortex activation was unaltered. These findings provide direct experimental evidence in humans linking frontal-lobe limbic activity with pain affect, as originally suggested by early clinical lesion studies.

2,444 citations


"Burst spinal cord stimulation for l..." refers background in this paper

  • ...Pain stimuli are indeed processed in parallel (13) by two pathways: a medial affective/attentional pain pathway and a lateral discriminatory pathway (15, 27, 28)....

    [...]

Journal ArticleDOI
TL;DR: Data suggest that hemodynamic responses to pain reflect simultaneously the sensory, cognitive and affective dimensions of pain, and that the same structure may both respond to pain and participate in pain control.
Abstract: Brain responses to pain, assessed through positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are reviewed. Functional activation of brain regions are thought to be reflected by increases in the regional cerebral blood flow (rCBF) in PET studies, and in the blood oxygen level dependent (BOLD) signal in fMRI. rCBF increases to noxious stimuli are almost constantly observed in second somatic (SII) and insular regions, and in the anterior cingulate cortex (ACC), and with slightly less consistency in the contralateral thalamus and the primary somatic area (SI). Activation of the lateral thalamus, SI, SII and insula are thought to be related to the sensory-discriminative aspects of pain processing. SI is activated in roughly half of the studies, and the probability of obtaining SI activation appears related to the total amount of body surface stimulated (spatial summation) and probably also by temporal summation and attention to the stimulus. In a number of studies, the thalamic response was bilateral, probably reflecting generalised arousal in reaction to pain. ACC does not seem to be involved in coding stimulus intensity or location but appears to participate in both the affective and attentional concomitants of pain sensation, as well as in response selection. ACC subdivisions activated by painful stimuli partially overlap those activated in orienting and target detection tasks, but are distinct from those activated in tests involving sustained attention (Stroop, etc.). In addition to ACC, increased blood flow in the posterior parietal and prefrontal cortices is thought to reflect attentional and memory networks activated by noxious stimulation. Less noted but frequent activation concerns motor-related areas such as the striatum, cerebellum and supplementary motor area, as well as regions involved in pain control such as the periaqueductal grey. In patients, chronic spontaneous pain is associated with decreased resting rCBF in contralateral thalamus, which may be reverted by analgesic procedures. Abnormal pain evoked by innocuous stimuli (allodynia) has been associated with amplification of the thalamic, insular and SII responses, concomitant to a paradoxical CBF decrease in ACC. It is argued that imaging studies of allodynia should be encouraged in order to understand central reorganisations leading to abnormal cortical pain processing. A number of brain areas activated by acute pain, particularly the thalamus and anterior cingulate, also show increases in rCBF during analgesic procedures. Taken together, these data suggest that hemodynamic responses to pain reflect simultaneously the sensory, cognitive and affective dimensions of pain, and that the same structure may both respond to pain and participate in pain control. The precise biochemical nature of these mechanisms remains to be investigated.

2,113 citations

Related Papers (5)