Neurological

Some improvements in pain from high-frequency spinal cord stimulation after conventional treatment fail

Radiofrequency stimulation can be an effective treatment option for some patients who have failed conventional spinal cord stimulation therapy (SCS) for chronic pain. These results of a prospective study were published in the European Journal of Pain.

For this study, the researchers recruited 18 patients between 2016 and 2018 who were treated at the Virgen de las Nieves University Hospital in Spain who had standard tonic SCS but treatment failed. They offered 10 kHz radio frequency (HF10) SCS to patients who were using their previously implanted device for tonic SCS therapy (2 Medtronic or SJM epidural electrodes). HF10-SFS was achieved via a SENZA (NevroÒ) high frequency generator in which researchers tested ³3 programs over a period of two weeks. They defined the treatment success as a 50% improvement as assessed by the Functional Rating Index (FRI) and the Numerical Pain Rating Scale (NPRS).

The mean age of the patients was 49.38 ± 9.1 years; 72.2% were men; 27.8% were obese; 83.3% were diagnosed with failed back surgery syndrome; and 72.2% had used preoperative opioids.

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A total of 11 patients reported HF10-SFS success and 7 had treatment failure.

Among patients who reported treatment success, the mean perceived improvement from baseline was 52.7% and the NPRS decreased from 7.16 to 4.06 points for the lower back. The perceived improvement in limb pain was 56.8% and the NPRS decreased from 8.77 to 3.45 points. Only 3 patients reported an improvement (³50%) in both their lower back and limb pain.

For the treatment failure cohort, the mean perceived improvement was 13.5% and 19.2% for the lower back and limbs, respectively. Three patients reported no improvement in their lower back and two had no improvement in their limb pain.

After 12 months, the FRI values ​​improved by 28.4% (95% CI, 21.19-35.62); P = 0.0001; 36% stopped using opioids and 45% reduced opioid use.

The patient groups differed significantly by gender in terms of success, with all malpractice errors occurring in men (P = 0.037). Treatment failure occurred in a population with a mean body mass index (BMI) of 30.05 ± 3.19 kg / m2 compared to 25.17 ± 3.33 kg / m2 for the successes (P = 0.007) . Male gender in a linear model (coefficient -42.7% [95% CI, -85 to -0.4]) and BMI (coefficient 6.7% [95% CI, 1.8-11.5]) had significant coefficients.

This study was limited due to the small sample size and significant cohort heterogeneity.

These data demonstrated that HF10-SCS was effective in reducing lower back and / or limb pain in patients, particularly women and non-obese patients, who experienced treatment failure with tonic SFS.

reference

Cordero Tous N., Sánchez Corral C., Ortiz García IM, Jover Vidal A., Gálvez Mateos R., Olivares Granados G. High-frequency spinal cord stimulation as rescue therapy for chronic pain patients with failure of conventional spinal cord stimulation. Eur J Pain. Published online April 7, 2021. doi: 10.1002 / ejp.1776

This article originally appeared on Clinical Pain Advisor

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