Spinal Cord Stimulation
Burst Spinal Cord Stimulation Evaluated in Patients With Failed Back Surgery Syndrome and Painful Diabetic Neuropathy

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Objective:

Spinal cord stimulation (SCS) is used for treating intractable neuropathic pain. Generally, it induces paresthesia in the area covered by SCS. Burst SCS was introduced as a new stimulation paradigm with good pain relief without causing paresthesia. Good results have been obtained in patients who were naive to SCS. In this study we assess the effectiveness of burst stimulation in three groups of chronic pain patients who are already familiar with SCS and the accompanying paresthesia.

Methods:

Forty-eight patients with at least six months of conventional, tonic stimulation tested burst stimulation for a period of two weeks. They were classified in three different groups: a cross-section of our population with painful diabetic neuropathy (PDN), a cross-section of our population with failed back surgery syndrome (FBSS), and FBSS patients who over time had become poor responders (PR) to SCS. Visual analog scale scores for pain were assessed prior to implantation, with tonic stimulation, and after two weeks of burst stimulation.

Results:

Burst stimulation reduced pain significantly for almost all patients. When compared with tonic stimulation, burst stimulation led to a significant additional pain reduction of on average 44% in patients with PDN (p < 0.001) and 28% in patients with FBSS (p < 0.01). Patients from the PR group benefitted less from burst stimulation on average. In addition, burst stimulation caused little or no paresthesia whereas tonic stimulation did induce paresthesia. Most patients preferred burst stimulation, but several preferred tonic stimulation because the paresthesia assured them that the SCS was working.

Conclusion:

About 60% of the patients with tonic SCS experienced further pain reduction upon application of burst stimulation.

Section snippets

INTRODUCTION

Spinal cord stimulation (SCS) is an invasive technique that administers electrical stimulation to the dorsal columns of the spinal cord to reduce pain perception. SCS has shown to be an effective treatment for various neuropathic pain conditions (1., 2., 3., 4., 5., 6., 7.).

To achieve the most beneficial pain relief for an individual patient, SCS parameters like the configuration of active electrodes, the stimulation frequency, pulse width, and pulse amplitude can be adjusted to the patient’s

METHODS

Patients with an Eon IPG (St. Jude Medical) and using tonic SCS for at least six months tested burst stimulation for two weeks. Three groups of patients were included: two groups of patients who participated in previous studies—that is, patients with painful diabetic neuropathy (PDN) and patients with low back and leg pain (failed back surgery syndrome [FBSS] (14)), and one group of patients with low back and leg pain (FBSS) who over time had started to experience insufficient effect of tonic

Study Population

Forty-eight patients from Medisch Spectrum Twente Hospital with an SCS system and tonic stimulation participated in the study. Their average age was 56 years (SD = 9; range: 29–80 years) and they had on average been experiencing pain for 10 years (SD = 6; range: 2–30 years). All patients had been using tonic stimulation for at least six months (mean = 2.5 years, SD = 2.6, range: 0.5–18 years) and evaluated burst stimulation for a two-week period.

Three different groups of patients were included:

DISCUSSION

Burst stimulation caused pain reduction in almost all patients. On average, burst stimulation caused a significantly larger pain reduction in all three patient groups than tonic stimulation, and burst stimulation caused little or no paresthesia in most patients. About 60% of patients (67% for PDN, 58% for FBSS, and 50% for the PR group) experienced further pain reduction when applying burst stimulation in comparison with tonic stimulation. An increase in perceived pain as compared with tonic

CONCLUSION

Burst stimulation compares favorably with tonic stimulation for most patients, generally without eliciting paresthesia. On average, burst stimulation causes significantly more pain reduction in patients with PDN and in patients with FBSS. A trial period of at least two weeks of burst stimulation for every patient with a spinal cord stimulator would likely increase the efficacy of SCS therapy. Still, further research should elucidate optimal burst stimulation parameters for patients who are

Authorship Statements

Ms. de Vos, Ms. Bom, and Drs. Vanneste, Lenders, and de Ridder designed the study. Ms. de Vos, Ms. Bom, and Dr. Lenders conducted the study, including patient recruitment and data collection. Ms. de Vos, Ms. Bom and, Dr. Vanneste performed data analysis. Ms. de Vos prepared the manuscript draft with important intellectual input from Ms. Bom, and Drs. Vanneste, Lenders, and de Ridder. All authors approved the final manuscript.

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