Prospective study shows good efficacy with high-frequency spinal cord stimulation in surgery-naïve patients

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A study published in the journal Neuromodulation reports good efficacy with high-frequency spinal cord stimulation with notable reductions on the numerical rating scale back and leg pain in patients who had no previous spine surgery.

While there has been a multitude of evidence supporting the beneficial effects of spinal cord stimulation (SCS) in patients suffering from chronic pain syndromes following spinal surgery has been published in the last decade, evidence is scarce for the use of high frequency SCS in the treatment of surgery naïve patients suffering from lower back pain. Sebastian A Ahmadi (Universitätsklinikum Düsseldorf, Düsseldorf, Germany) and colleagues therefore sought to evaluate the outcomes in these patients at their centre.

From June 2014 to April 2015, Ahmadi and colleagues prospectively enrolled patients suffering from lower back pain alone or in conjunction with leg pain in a trial of high-frequency spinal cord stimulation. None of the patients enrolled had undergone surgical procedures of the lumbar spine. Patients included in the study suffered medically intractable lower back pain and were deemed ineligible for spine surgery. All patients underwent trial stimulation for at least one week. Pain levels were assessed daily during initial stay, four weeks later and then every three months. Different pre-programmed modes of high-frequency spinal cord stimulation were changed if pain persisted or increased during trial or post-implant follow-up.

Eight patients (four male, four female) underwent high-frequency spinal cord stimulation trials. Mean age was 60±4.8 years. Mean numeric rating scale (NRS) baseline intensity for back pain was 8.9±0.23 and 8.1±0.6 for leg pain. All patients achieved meaningful reductions in pain intensities and underwent implantable pulse generator (IPG) implantation at a mean interval of 13 days. The mean follow-up time was 306 days.

“Mean back pain reduction from baseline at last follow-up was −4.13±0.85, and −6.2±1.03 for leg pain. Two patients showed skin irritations and localised pain at the IPG site. Both patients underwent surgery to replant the IPG. No infections were seen in any of the eight patients enrolled,” Ahmadi et al report.

This prospective study provides some evidence for the use of high-frequency spinal cord stimulation in pain patients who have not had previous surgery. Investigators were able to show good efficacy with high-frequency spinal cord stimulation with meaningful NRS reductions for back and leg pain, after a mean follow-up of 10 months.