#Dorsal column stimulation trial

At this point, 77% of the participants had gone into pain remission, meaning their pain was 0 to 3 on the visual analog scale (VAS). At 26 weeks the median pain relief was 76.4%. At 26 weeks, the preferred program was assessed. Participants were blinded to the nature of the programming and program step-up (dose rescue) was allowed. At 6 weeks, this was reprogrammed to 60%, at 10 weeks to 40% and at 14 weeks to the patient’s preferred program.

#Dorsal column stimulation trial

After evaluation of this trial period, patients were given a permanent implant which was programmed to 80%. 7 Following screening, enrolment and recording of baseline features, participants (n=27) underwent a trial lasting 2-4 days with the Subwave programmed at 80% of the patient’s stimulation perception threshold. Russo et al have performed a clinical trial to evaluate the efficacy and safety of their novel stimulation waveform in the treatment of chronic lower back pain. and higher, 8 and that dendrite action potentials are optimal when the frequency exceeds 75Hz. 7 Previous studies have shown that dendrites respond from a pulse width of 900 µs. Russo et al have developed a novel stimulation waveform (“Subwave”) comprising a T9/10 disc bipole to access the point of major traffic synapsing in the spinal cord stimulation frequency of 100 Hz to achieve sufficient net activation charge extra wide pulse width of 1000 µs to spread activation laterally to capture dorsal horn action potentials and an amplitude set at 80% of the patient’s stimulation perception threshold or lower, enabling them to remain paraesthesia-free but with adequate charge per pulse. It should preferentially stimulate the dendrites and not produce paresthesia. In addition, it must penetrate beyond Lamina I to active Lamina II-IV. We need the field to swing over to the lateral aspect of the dorsal horn. Stimulating the dendrite poses several challenges. 6 This has led to the hypothesis that stimulation of the dendrite might affect pain pathways in humans. 5 Dorsal horn dendrites are also attractive targets because they are involved in long-term potentiation of synaptic strength (LTP) in nociceptive pathways. 4 Animal studies have established that abnormalities of dendritic spine morphology are associated with abnormal nociceptive function, including neuropathic pain. 3 It is divided into six layers, known as laminae, and comprise a number of different cell types: islet cells, filamentous cells, curly cells and stellate cells. Neurons in the spinal dorsal horn process sensory information, which is then transmitted to several brain regions, including those responsible for pain perception. The dorsal horn of the human spinal cord is recognized as a key site for initial pain processing. However, in recent years, the attention of researchers has turned to non-axonal stimulation targets, such as dorsal columns, dorsal roots, and dorsal horns. Conventional techniques have focused on axons in the dorsal column.

Technological advances in stimulator design and treatment protocols have not correlated with significant improvements in clinical outcomes, and we may be reaching the limits of what can be achieved using established techniques. 1 However, our incomplete understanding of the mechanisms underlying pain relief by SCS has led to a plateau in efficacy. Spinal cord stimulation (SCS) is an established technique for the treatment of chronic pain associated with many different disease entities, including neuropathic pain, intractable pain, headache, and angina pain, and its clinical efficacy is well documented. President, International Neuromodulation Societyĭirector of Hunter Pain Specialists, Hamilton Day Surgery Centre, Genesis Research Services, Broadmeadow, AustraliaĬo-Director, Innervate Pain Management Program, Newcastle, AustraliaĬhronic pain is a heterogenous, complex condition that is associated with significant burdens for both patients and the healthcare systems.