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Spinal Cord Stimulators

Spinal Cord Stimulators. Spinal Cord Stimulation Therapy. FDA-approved therapy to treat chronic pain of the trunk and/or limbs Used to treat patients with neuropathic pain SCS is considered a third tier pain therapy SCS is not a cure. Pain. Nociceptive Pain

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Spinal Cord Stimulators

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  1. Spinal Cord Stimulators

  2. Spinal Cord Stimulation Therapy • FDA-approved therapy to treat chronic pain of the trunk and/or limbs • Used to treat patients with neuropathic pain • SCS is considered a third tier pain therapy • SCS is not a cure

  3. Pain • Nociceptive Pain • Harmful stimulus is applied to skin, joints, muscles and nociceptive nerve endings are activated • Sharp shooting/ dull aching pain • Typically lessens over time • Responds well to traditional treatments • Neuropathic Pain • Arise spontaneously without activation of nociceptors • Typically Chronic pain • Does not respond well to traditional treatments • Tactile Hypersensitivity- allodynia and hyperalgesia

  4. How does SCS Therapy work? • Stimulator leads placed along the dorsal column of the spinal cord produce paresthesia sensation to help mask pain signals • There are 3 types of SCS systems that can be used depending on the patient’s pain • Conventional IPG system • Rechargeable IPG System • Radiofrequency (RF) system

  5. Spinal Cord Stimulator Procedure

  6. Theories Behind SCS Therapy • Gate Control Theory • By stimulating the large A beta blocks the transmission of pain signals via the small C fibers • Stimulating supraspinal pathways sends signals up the dorsal column to the brain stem and is then returned to spinal cord via dorsal Longitudinal fasciculus to mediate the pain pathways • Descending Inhibition of Pain pathways • Stimulation of the adrenergic sympathetic neurons close the gate • Stimulation of Dorsal Nerve root fibers

  7. Benefits of SCS • Pain relief • Reduction in pain medication intake • Improvement of depression symptoms • Return to work • Return to daily activities • Increase quality of life

  8. SCS Candidates • SCS is a last resort treatment of chronic pain when other therapies have failed • Patients must have a multidisciplinary screening to determine if they would be a good candidate • Successful Trial Placement • Patients must be motivated and willing to try the treatment

  9. Successful SCS treatments • SCS has been used since 1967 for the treatment of chronic pain • SCS has successfully treated numerous painful disorders • Failed Back Surgery Syndrome/ Arachnoiditis • Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome • Angina • Stump Pain/ Phantom Limb Pain • Peripheral neuropathies • Radiculopathies • Peripheral Vascular Disease/ Ischemic Pain

  10. Failed Back Surgery Syndrome • Pain that persists after one or more surgical procedure on the lumbo-sacral spine • Most common diagnosis for patients who receive SCS • Etiology is difficult to pinpoint • Most common cause of FBSS- improper patient selection • 1-10% of patients will be worse after surgery • Characteristics: back/ leg pain, numbness/tingling & weakness in legs, stabbing burning and shooting pain

  11. FBSS Results • Leveque, J et al. • Randomized Controlled Trial of 16 patients with FBSS • ANS St. Jude Medical Company Case Study • Case Study of a patient with FBSS

  12. Complex Regional Pain Syndrome • AKA: Reflex Sympathetic Dystrophy • Multi-symptom/ Multi-system • Characteristics: • Soft tissue injury/ immobilization • Temperature difference between affected and unaffected extremity of at least 1°C • Tactile hypersensitivity • Cutaneous changes

  13. CRPS and SCS Research Results • Kemler, M et al. • Randomized Control Trial of patients with Chronic Reflex Sympathetic Dystrophy • Harney, D et al. • Review of case studies with patients with CRPS treated with SCS • Overall all SCS groups had a 60-70% success rate, narcotic intake was reduced and improvement in activity and quality of life

  14. SCS and Angina • Number 1 Reason for Spinal Cord Stimulator implantation in Europe • Main Clinical Symptoms are related to ischemic heart pain • Pain in chest, arms, throat and neck • Results: • Improved Coronary blood flow but no increase in totally flow • Altered sympathetic/ parasympathetic balance • Research- Ferrero, P et al., De Jongste et al.

  15. Leg pain • Characteristics • Pain in leg when walking • Numbeness/tingling in leg • Burning pain that is worse at night • Phantom limb sensation- uncontrollable movements • Sensitive Pain • Research • Jivegard et al. • Raina, et al.

  16. Questions??

  17. References ANS: St. Jude Medical Company. (n.d.). Spinal Cord Stimulation: A Promising Treatment Option for Your Patients With Chronic Pain [Pamphlet]. Boston Scientific. (2007). Taking Control of Your Pain: The First Step [Pamphlet]. USA: Precision Plus. Cameron, T., Ph.D. (2004, March). Safety and Efficacy of Spinal Cord Stimulation for the Treatment of Chronic Pain: a 20-year Literature Review. Journal of Neurosurgery: Spine, 100, 254-267. Ferrero, P., MD., Grimaldi, R., MD., Massa, R., MD., & Chiribri, A., MD. (2007, January). Spinal Cord Stimulation for Refractory ANgina in a Patient Implanted with a Cardioverter Defibrillator. PACE, 30, 143-146. Greenwald, T., RN., & Ryan, B., RN. (2004, June). Spinal Cord Stimulation Overview. In Mayfield Clinic. Retrieved January 15, 2009, from http://www.mayfieldclinic.com/PE-STIM.htm Harney, D., Magner, J. J., & O’Keeffe, D. (2004, June). Complex Regional Pain Syndrome: the case for Spinal Cord Stimulation (a Brief Review). Injury: International Journal of the Care of the Injured, (36), 357-362.

  18. References Continued… Kemler, M. A., MD., Barendse, G. A., MD., & Van Kleef, M., M.D., Ph.D. (2000, August). Spinal Cord Stimulation in Patients with Chronic Reflex Sympathetic Dystrophy. The New England Journal of Medicine, 618-624. Leveque, J.-C., Villicencio, A. T., & Bulsara, K. R., MD. (2008, October). Spinal Cord Stimulation for Failed Back Surgery Syndrome. Neuromodulation, 4(1), 1-9. North, R., MD. (2007). Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain. American Academy of Pain Medicine, 8(S4), S20-S275. Raina, G. B., Piedimonte, F., & Micheli, F. (2007). Posterior Spinal Cord Stimulation in a Case of Painful Legs and Moving Toes. Stereotactic and Functional Neurosurgery, (85), 307-309.

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