Burst SCS Microdosing Is as Efficacious as Standard Burst SCS in Treating Chronic Back and Leg Pain: Results From a Randomized Controlled Trial
| Autor: | Jan Vesper, Heike Littges, Lalit Venkatesan, Katja Poeggel-Kraemer, Filippo Agnesi, Stefan Schu, Tony Van Havenbergh, Philipp J. Slotty, Pieter Van Looy |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Microdosing Visual analogue scale Salvage therapy Stimulation law.invention Tonic (physiology) 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Randomized controlled trial 030202 anesthesiology law medicine Humans Single-Blind Method Prospective Studies Aged Pain Measurement Spinal Cord Stimulation business.industry Leg pain General Medicine Middle Aged Treatment Outcome Anesthesiology and Pain Medicine Neurology Back Pain Neuropathic pain Female Neurology (clinical) Chronic Pain business 030217 neurology & neurosurgery |
| Zdroj: | Neuromodulation: Technology at the Neural Interface. 22:190-193 |
| ISSN: | 1094-7159 |
| DOI: | 10.1111/ner.12883 |
| Popis: | Introduction The burst waveform, a recent innovation in spinal cord stimulation (SCS), can achieve better outcomes than conventional tonic SCS, both for de novo implants and as a salvage therapy. Burst stimulation delivers more energy per second than tonic stimulation, which is a consideration for battery consumption. The clinical effectiveness of an energy-conserving strategy was investigated. Methods Subjects were experienced users of BurstDR SCS for back and leg pain. Three 2-week stimulation paradigms were presented in blinded random order: standard (continuously delivered) BurstDR, microdosing A: 5 sec of BurstDR alternating with 5 sec of no stimulation, and microdosing B: 5 sec of BurstDR alternating with 10 sec of no stimulation. The primary outcome for each paradigm was change in pain ratings, and secondary outcomes included changes in scores for quality of life, satisfaction, and preference. Results Twenty-five subjects assessed all three stimulation paradigms. There were no significant differences in pain (visual analog scale) or quality of life (EQ-5D) when comparing standard burst outcomes with those of microdosing A and, separately, microdosing B. Microdosing paradigms were graded with slightly higher level of satisfaction and were generally preferred above standard burst stimulation. Discussion These results suggest that the use of energy-efficient burst microdosing stimulation paradigms with alternating stimulation-on and stimulation-off periods can provide clinically equivalent results to standard burst stimulation. This is important for extending SCS battery life. Further research is needed to comprehensively characterize the clinical utility of this approach and the neurophysiological mechanisms for the maintenance of pain relief during stimulation-off periods. |
| Databáze: | OpenAIRE |
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