Long-term effects of high-dose SCS for treatment of chronic pain in patients with CBLP and CRPS: outcomes of a prospective case series.

I.D. Eikelboom-Demper, E. Siegers-Bennink,  P. Brocades Zaalberg, A.Q. Le, J.E.G.C. van Haandel
St Jansdal Hospital, Harderwijk, The Netherlands

Background: High-dose spinal cord stimulation (HD-SCS) is a programming option at higher stimulation frequencies and longer pulse durations, i.e. delivering greater electrical charges per unit time compared to conventional (low-dose) SCS (1). The goal of this research was to prospectively investigate the effect of HD-SCS in patients with chronic pain in our standard-of-care SCS pain practice.

Method: Patients selected for SCS were included and treated according to standard of care. Placement of an 8-polar lead was optimized upon paresthesia coverage of the painful area. During the trial period first HD-SCS was offered. In case of sub-optimal outcomes with HD-SCS, conventional SCS was tried. Patients who responded to HD-SCS, received a rechargeable pulse generator, were programmed with a frequency of 500Hz and pulse duration of 500μs, and prospectively followed. Pain was scored using a weighted VAS score. Furthermore, information on pain medication use was collected.

Results: 30 of the 32 patients, responded to HD-SCS. Twenty-six patients, age 51 (SD 34) years, 22 with FBSS and 4 with CRPS, had a follow-up of 6-12 months of whom the results are presented here. The average pain decreased from VAS 7.0 (SD 1.1) prior to SCS, to 2.5 (SD 1.4), and 2.3 (SD 1.4), at 6- and 12-months follow-up, respectively. 
Pain medication was taken by 85% of patients before SCS and by 45% and 20% of patients, respectively at 6- and 12-months SCS.

Conclusion: HD-SCS is an effective long-term stimulation modality for treatment of chronic pain in patients with CBLP and CRPS.

1) Miller JP, et al. Neuromodulation. 2016 Jun;19(4):373-84.

LONG-TERM EFFECTS OF HIGH-DOSE SCS FOR TREATMENT OF CHRONIC PAIN IN PATIENTS WITH CBLP AND CRPS: OUTCOMES OF A PROSPECTIVE CASE SERIES