AOCPMR 2024 Mid-Year Meeting-Spinal Neuromodulation - State of Play

Video Transcription

Video Summary

The video discusses spinal cord stimulation (SCS) as a treatment for chronic neuropathic pain conditions, focusing on its mechanisms, technologies, applications, and limitations. SCS works by modulating central sensitization, intercepting pain signals at the spinal cord level, primarily targeting dorsal columns or dorsal root ganglion (DRG). Various waveforms are used: traditional low-frequency paresthesia-based stimulation, burst stimulation replicating natural neuronal firing, and high-frequency (e.g., 10 kHz) sub-perceptual stimulation. Newer technologies include closed-loop systems with evoked compound action potential (ECAP) feedback that adjust stimulation in real-time to maintain effectiveness and reduce side effects.<br /><br />The main clinical indications have been post-laminectomy syndrome (failed back surgery), complex regional pain syndrome (CRPS), and post-amputation pain. Recent FDA approvals have expanded use to diabetic and chemotherapy-induced neuropathies, broadening patient eligibility. DRG stimulation offers highly targeted therapy for focal pain but involves technically challenging implantation and limited MRI compatibility.<br /><br />Device selection depends on factors like MRI safety, battery life (rechargeable vs. non-rechargeable), waveform preference, and company support. Loss of efficacy over 18-24 months is a notable issue, prompting interest in alternating stimulation patterns to avoid habituation. Overall, SCS shows promise with evolving technology, but patient selection and long-term management remain critical for success.

Keywords

ultrasound-guided shoulder injections

needle visualization techniques

probe handling and ergonomics

standoff oblique method

glenohumeral injections

suprascapular nerve block

regenerative medicine alternatives

spinal cord stimulation

chronic neuropathic pain

central sensitization

dorsal root ganglion

burst stimulation

closed-loop systems

post-laminectomy syndrome

complex regional pain syndrome