Neuromodulation最新文献

{"title":"Neurostimulation for the Treatment of Cancer-Induced Pain: A Scoping Review","authors":"Peter D. Vu MD ,&nbsp;Steven Mach MD ,&nbsp;Saba Javed MD","doi":"10.1016/j.neurom.2024.10.006","DOIUrl":"10.1016/j.neurom.2024.10.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Cancer pain is among the most prevalent and challenging symptoms in cancer care, with up to 95% of patients with late-stage cancer experiencing moderate-to-severe pain. Conventional pharmacologic treatments, including opioids, carry risks, and patients’ conditions may be refractory to medical management or have contraindications. Neurostimulation techniques, such as spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), and peripheral nerve stimulation (PNS), have shown promise in treating treatment-induced cancer pain. However, a comprehensive review focusing on these techniques for cancer-induced pain alone is necessary.</div></div><div><h3>Materials and Methods</h3><div>A comprehensive literature review was conducted using Medline, Embase, and Cochrane Library data bases, focusing on studies from 2000 onward. Inclusion criteria included interventional and observational studies reporting on SCS, DRGS, and PNS in cancer-induced pain. Studies addressing treatment-induced pain, systematic reviews, meta-analyses, and non-English studies were excluded. Data were extracted and evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation system.</div></div><div><h3>Results</h3><div>The search yielded 831 references, with 24 studies meeting the inclusion criteria. Sixteen studies focused on SCS, seven on PNS, and two cases on DRGS. SCS showed significant pain reduction, with an average decrease in numeric rating scale (NRS) scores from 8.0 to 2.2 over an average 8.4-month follow-up period. PNS also indicated substantial pain relief, with NRS scores decreasing from 8.29 to 3.04 over an average 5.2-month follow-up period. DRGS, although less studied, showed a reduction in NRS scores from 6.0 to 1.0 over an average 6.0-month follow-up period. SCS was associated with a significant reduction in opioid use, with average reported morphine equivalent daily dose (MEDD) change from 1152.2 mg to 739.7 mg over an average 5.0-month period, whereas PNS and DRGS had limited impact on opioid consumption, with no reported MEDD change.</div></div><div><h3>Conclusions</h3><div>Our scoping review synthesizes evidence on neurostimulation interventions for treating cancer-induced pain. Current evidence suggests that interventions such as SCS, DRGS, and PNS may provide clinically meaningful pain relief in patients with cancer-induced pain. Several studies also reported improvements in functionality and quality of life. However, the level of evidence is limited owing to the lack of prospective comparative studies, clinical and methodologic heterogeneity, and small sample sizes.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 191-203"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Spinal Cord Stimulation Improve Sleep Disturbances Independently of Pain Relief in Patients With Chronic Pain? An Explorative, Observational Study","authors":"Emilia Nejatbakhsh MD ,&nbsp;Simon B. Kristensen PhD ,&nbsp;Christian Scherer MD ,&nbsp;Kaare Meier MD, PhD ,&nbsp;Morten Blichfeldt-Eckhardt MD, PhD","doi":"10.1016/j.neurom.2024.06.004","DOIUrl":"10.1016/j.neurom.2024.06.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Chronic pain poses a significant health challenge worldwide and is associated with both disability and reduced quality of life. Sleep disturbances are reported in 67% to 88% of patients with chronic pain.</div><div>Pain and sleep affect each other reciprocally; we aimed to study this bidirectional relationship in patients treated with spinal cord stimulation (SCS) for chronic pain. Specifically, we investigated whether sleep improves after treatment with SCS and whether this improvement may be mediated by pain reduction.</div></div><div><h3>Materials and Methods</h3><div>An observational cohort study was conducted in patients with chronic neuropathic pain treated with SCS at a single neurosurgical department in Denmark. Outcomes were assessed preoperatively and at three, six, and 12 months postoperatively, and thereafter annually. Primary outcomes were pain intensity (numeric rating scale) and insomnia at first follow-up (Insomnia Severity Index). The association between sleep and pain was investigated using linear regression and mediation analysis.</div></div><div><h3>Results</h3><div>Forty-three patients were included in the study. The mean insomnia score was reduced by 25% from 18.1 (SD 6.0) to 13.5 (SD 6.6) (<em>p</em> = 0.0001). Pain intensity was reduced 38% from 7.4 (SD 1.6) to 4.6 (SD 2.1) at the first follow-up (<em>p</em> ≤ 0.0001). Changes in pain and changes in insomnia scores were significantly but weakly associated (regression coefficient = 1.3, 95% CI [0.3; 2.2], <em>p</em> = 0.008, <em>r</em>^<em>2</em> = 15.7%); and changes in pain score were not found to mediate changes in sleep score (β = −0.02, 95% CI [−0.15; 0.11], <em>p</em> = 0.76).</div></div><div><h3>Conclusions</h3><div>We found that patients treated with SCS showed significant improvements in both insomnia and pain intensity at first follow-up. Improvements in insomnia and pain intensity were significantly but weakly associated, and improvements in pain intensity score did not mediate improvements in insomnia score. Thus, improvements in self-reported insomnia in patients treated with SCS for chronic pain may predominantly be caused by other factors than reduced pain intensity.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 315-322"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pudendal Nerve Block by Adaptively Stepwise Increasing the Intensity of High-Frequency (10 kHz) Biphasic Stimulation","authors":"Jianan Jian PhD ,&nbsp;Jicheng Wang PhD ,&nbsp;Bing Shen DVM ,&nbsp;Zhijun Shen MD ,&nbsp;Khari Goosby BS ,&nbsp;Joseph Scolieri BS ,&nbsp;Jonathan Beckel PhD ,&nbsp;William C. de Groat PhD ,&nbsp;Changfeng Tai PhD","doi":"10.1016/j.neurom.2023.03.015","DOIUrl":"10.1016/j.neurom.2023.03.015","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to determine whether adaptively stepwise increasing the intensity of a high-frequency (10 kHz) biphasic stimulation (HFBS) can produce nerve conduction block without generating a large initial response.</div></div><div><h3>Materials and Methods</h3><div>In anesthetized cats, three cuff electrodes were implanted on the left pudendal nerve<span> for stimulation or block. The urethral pressure increase induced by pudendal nerve stimulation was used to measure the pudendal nerve block induced by HFBS.</span></div></div><div><h3>Results</h3><div>HFBS applied suddenly with a large step increase in intensity induced a large (86 ± 16 cmH₂<span>O) urethral pressure increase before it blocked pudendal nerve conduction. However, HFBS applied by adaptively stepwise increasing the intensity every 10 to 60 seconds over a long period (33–301 minutes; average 108 ± 35 minutes) with many small intensity increases (0.005–0.1 mA) induced no response or low-amplitude high-frequency urethral pressure changes before it blocked pudendal nerve conduction. The minimal HFBS intensities required by the two different methods to block pudendal nerve conduction are similar.</span></div></div><div><h3>Conclusion</h3><div>This study is important for better understanding the possible mechanisms underlying the HFBS-induced nerve block and provides the possibility of developing a new nerve block method for clinical applications in which an initial large response is a concern.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 249-255"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9416336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restorative Neurostimulation of the Multifidus for Chronic Low Back Pain After Prior Lumbar Spinal Surgery: A Single-Center, Consecutive Case Series","authors":"Ian R. Whittle MBBS, MD, PhD ,&nbsp;Derek Yull MBBS, BSc ,&nbsp;Allen Huang MBBS ,&nbsp;Sally Fish DipCouns. ,&nbsp;Dani Chene MBBS ,&nbsp;Michael Selby MBBS ,&nbsp;Kyle Craig BA Sci, MClinExPhys. ,&nbsp;Eleanor Clausen BSc, RGN, Dip Prof Studies, ENB ,&nbsp;Yun-Hom Yau MBChB","doi":"10.1016/j.neurom.2024.10.011","DOIUrl":"10.1016/j.neurom.2024.10.011","url":null,"abstract":"<div><h3>Objectives</h3><div>Restorative neurostimulation of the lumbar multifidus muscle is a novel therapy for chronic nonspecific low back pain (CLBP). Previous studies have excluded patients with prior lumbar surgery. In this study, we describe outcomes in patients with CLBP after prior lumbar surgery.</div></div><div><h3>Materials and Methods</h3><div>This was a single-center, consecutive case series. The primary outcome measure was the change from baseline numeric rating score (NRS) for low back pain (LBP) and Oswestry Disability Index (ODI) in the first 12 months after treatment. Secondary outcomes were number of patients having minimal clinically important difference (MCID) in NRS and ODI scores, Short Assessment of Patient Satisfaction with their management, relationships between type of prior surgery and outcome, and incidence of adverse events.</div></div><div><h3>Results</h3><div>The cohort comprised 26 patients (12 men; 14 women; mean age 56 years) who had their lumbar surgery a mean 6.9 years previously; 16 were followed up for 12 months and nine for &gt;six months. One patient (3.6%) had a postoperative infection and required device removal. Both mean ODI and LBP NRS and their 95% CIs decreased serially from baseline 41.8 (36.5–46.5) to 29.3 (22.1–36.6) at six months and 28.1 (21.8–34.4) at 12 months (ODI), and from 6.4 (5.5–7.0), 3.8 (3.1–4.6) and 3.6 (2.5–4.7), respectively, for NRS. Patient levels of satisfaction with treatment were very high. MCIDs were observed in ten patients (40%) who experienced improvement in both their ODI (by &gt;10) and NRS (by &gt;2), and in ten patients who experienced improvement in one of these variables but not the other. The type of prior lumbar surgery did not influence outcomes. There were no device-related complications.</div></div><div><h3>Conclusions</h3><div>The early outcome profiles after restorative neurostimulation after lumbar spinal surgery are similar to those reported in patients without prior surgery. Further prospective clinical studies are required to establish the validity of these findings.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 297-305"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Stimulation for Pain Management: A Survey of Clinical Practice Patterns","authors":"Jay Karri MD, MPH ,&nbsp;Eellan Sivanesan MD ,&nbsp;Amitabh Gulati MD ,&nbsp;Vinita Singh MD, MS ,&nbsp;Soun Sheen MD ,&nbsp;Bhavana Yalamuru MBBS ,&nbsp;Eric J. Wang MD ,&nbsp;Saba Javed MD ,&nbsp;Matthew Chung MD ,&nbsp;Rohan Sohini ,&nbsp;Nasir Hussain MD ,&nbsp;Ryan S. D’Souza MD","doi":"10.1016/j.neurom.2024.08.011","DOIUrl":"10.1016/j.neurom.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Clinical interest in and utilization of peripheral nerve stimulation (PNS) for treating chronic pain has significantly increased in recent years owing to its potential for providing analgesia and improved function and quality of life in comparison with pharmacologic treatments. However, the relative infancy of PNS-specific systems and limited clinical practice guidance likely contribute to significant variation in PNS utilization patterns.</div></div><div><h3>Objectives</h3><div>We sought to conduct a survey study to characterize PNS-specific clinical practices and propose the next steps in standardizing key practices for PNS utilization.</div></div><div><h3>Materials and Methods</h3><div>A 19-question survey exploring PNS-relevant clinical parameters was disseminated online to pain physicians in practice. Descriptive statistics were used to summarize results.</div></div><div><h3>Results</h3><div>A total of 94 responses were collected. Regarding patient selection, most practitioners would apply PNS to treat nociceptive pain from major joint osteoarthritis (77.7%) and chronic low back pain (64.9%), but not for axial neck pain (50.0%). In contrast, most would apply PNS to treat neuropathic pain from peripheral neuralgia (94.7%), pericranial neuralgia (77.7%), and cancer-related neuropathic pain (64.9%). In treating complex regional pain syndrome, most practitioners would apply PNS before all other forms of neuraxial neuromodulation (&gt;50% for each form). Similarly, for treating nonsurgical low back pain, most would apply PNS before neuraxial neuromodulation (&gt;50% for each form) but not before radiofrequency ablation (19.2%). Most routinely performed nerve blocks before PNS, mainly to confirm anatomical coverage (84.0%), and regarded a 50% to 75% interquartile range as the minimum analgesic benefit required before proceeding with PNS. Regarding nerve target selection for treating complex regional pain syndrome of the wrist/hand or ankle/foot, or knee osteoarthritis, we observed a very wide variance of PNS target locations and discrete nerves. Regarding “minor” adverse events, most reported not changing PNS utilization on encountering skin/soft tissue reactions (85.1%), minor infections (76.6%), or lead migration/loss of efficacy (50.0%). In comparison, most reported reducing PNS utilization on encountering skin erosion (58.5%), major infections (58.5%), or lead fractures (41.5%).</div></div><div><h3>Conclusions</h3><div>There is significant practice variation regarding the utilization of PNS across numerous key clinical considerations. Future research that explores the reasons driving these differences might help optimize patient selection, target selection, periprocedural management, and ultimately outcomes.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 348-361"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninfectious Complications of Dorsal Root Ganglion Stimulation: A Systematic Review and Meta-Analysis","authors":"Maarten Vanloon MD ,&nbsp;Tim Van Broeckhoven MD ,&nbsp;Vincent Raymaekers MD ,&nbsp;Dirk De Ridder MD, PhD ,&nbsp;Bart Billet MD ,&nbsp;Sacha Meeuws MD ,&nbsp;Tomas Menovsky MD, PhD ,&nbsp;Mark Plazier MD, PhD","doi":"10.1016/j.neurom.2024.10.010","DOIUrl":"10.1016/j.neurom.2024.10.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Dorsal root ganglion stimulation (DRGS) has emerged as a promising treatment for chronic neuropathic pain. However, its safety and complications are not fully understood, with existing literature primarily based on case reports, observational studies, and data base analyses. This systematic review and meta-analysis aims to assess the prevalence of noninfectious complications associated with DRGS, focusing on the trial phase, postimplantation period, and revisions, while identifying risk factors for these outcomes.</div></div><div><h3>Materials and Methods</h3><div>This systematic review adhered to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews database. A comprehensive search was conducted across multiple data bases in June 2023. Studies included randomized and nonrandomized trials, and cohort studies involving ≥20 patients with DRGS. The exclusion criteria were studies that did not differentiate DRGS-specific complications, focused solely on infections, lacked sufficient data for prevalence estimation, or presented only subanalyses from larger studies. A meta-analysis of proportions was performed to estimate the overall prevalence of complications.</div></div><div><h3>Results</h3><div>Thirteen studies with 634 participants were included. The pooled prevalence of all complications was 37% (95% CI: 19%–57%), with device-related complications being the most common at 27% (95% CI: 15%–42%). Lead fractures and migrations were the most frequently reported device-related complications with, respectively, 6% (95% CI: 2%–12%) and 6% (95% CI: 2%–10%). Procedure-related complications had a pooled prevalence of 1% (95% CI: 0%–5%), with dural puncture being the most common. The prevalence of DRGS explantations was 12%, primarily due to insufficient pain relief.</div></div><div><h3>Conclusions</h3><div>DRGS shows a safety profile comparable to that of spinal cord stimulation, with similar rates of lead migrations and fractures. Improvements in surgical techniques, technology, and clinician expertise are expected to reduce complications. Future research should standardize reporting practices and detail implantation techniques to better understand and refine best practices in DRGS implantation.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 234-248"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aims","authors":"","doi":"10.1016/S1094-7159(24)01288-1","DOIUrl":"10.1016/S1094-7159(24)01288-1","url":null,"abstract":"","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Page A3"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Pulsed Radiofrequency Duration in Patients With Chronic Lumbosacral Radicular Pain: A Randomized Double-Blind Study","authors":"Chan-Sik Kim MD,&nbsp;Yujin Kim MD,&nbsp;Doo-Hwan Kim MD, PhD,&nbsp;Hyun-Jung Kwon MD,&nbsp;Jin-Woo Shin MD, PhD,&nbsp;Seong-Soo Choi MD, PhD","doi":"10.1016/j.neurom.2024.03.006","DOIUrl":"10.1016/j.neurom.2024.03.006","url":null,"abstract":"<div><h3>Objectives</h3><div>We hypothesized that the duration of pulsed radiofrequency (PRF) application may affect the effectiveness of PRF in patients with chronic lumbosacral radicular pain (LRP).</div></div><div><h3>Materials and Methods</h3><div>In this prospective, double-blind, randomized study, 68 patients were randomly allocated to two groups: a 6-minute group, in which PRF was applied at 42 °C for 2 minutes followed by a 2-minute pause, repeated three times; and a 12-minute group, with a continuous application at 42 °C for 12 minutes. The total application time in each group was equal. After PRF, 2 to 3 mL of 1% lidocaine with 5 mg of dexamethasone was injected. The primary outcome was the intensity of leg pain measured using a numerical rating scale (NRS) three months after the procedure. The secondary outcomes were intensities of leg and back pain, the Oswestry Disability Index (ODI), the Medication Quantification Scale III (MQS), the Global Perceived Effect of Satisfaction (GPES), and the incidence of adverse events during follow-up. Primary and secondary outcomes were analyzed using a linear mixed-effect model in the modified intention-to-treat population.</div></div><div><h3>Results</h3><div>Each group comprised 34 patients. Three patients in each group did not receive the allocated intervention owing to alleviation of pain. The estimated NRS mean of leg pain at three months was 4.0 (95% CI, 3.2–4.9) and 4.5 (95% CI, 3.6–5.4) in the 6- and 12-minute groups, respectively, with no significant difference between groups (estimated mean difference, −0.5; 95% CI, −1.8 to 0.8; <em>p</em> = 0.436). Regarding the intensities of leg and back pain, ODI, MQS, and GPES, there was no significant difference between the two groups except for GPES at six months. No adverse events were observed in the groups.</div></div><div><h3>Conclusions</h3><div>Among patients with chronic LRP, a prolonged PRF application of 12 minutes, compared with 6 minutes, caused no significant difference in leg pain intensity.</div></div><div><h3>Clinical Trial Registration</h3><div>The <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> registration number under the Clinical Trial Registry of Korea for the study is KCT0003850; <span><span>https://cris.nih.go.kr</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 256-262"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cylindrical vs Paddle Leads in Spinal Cord Stimulation for the Long-term Treatment of Chronic Pain: A Systematic Review and Meta-analysis","authors":"Salim El Hadwe MD ,&nbsp;Filip Wronowski ,&nbsp;Sara Rehman ,&nbsp;Yaw Ofosu Ansong Snr ,&nbsp;Damiano G. Barone MD, PhD","doi":"10.1016/j.neurom.2024.10.007","DOIUrl":"10.1016/j.neurom.2024.10.007","url":null,"abstract":"<div><h3>Objectives</h3><div>This systematic review compares the long-term efficacy of cylindrical-lead spinal cord stimulation (CL-SCS) vs paddle-lead spinal cord stimulation (Paddle-SCS) for chronic pain management.</div></div><div><h3>Materials and Methods</h3><div>We included prospective and retrospective studies with at least ten patients reporting on the efficacy of either lead type. Primary outcomes were pain score reduction (measured by the visual analog scale [VAS] and numeric rating scale [NRS]) and 50% pain relief after at least 12 months. Secondary outcomes included functional disability and complications, such as lead migration and infection rates. Meta-analyses compared effect sizes, while meta-regression and subgroup analyses addressed heterogeneity.</div></div><div><h3>Results</h3><div>A total of 96 studies, comprising 7726 patients, met the inclusion criteria. Paddle-SCS demonstrated superior pain reduction, with a standardized mean difference (SMD) of 5.37 (95% CI [5.35, 5.38]) compared with CL-SCS, which had an SMD of 4.09 (95% CI [4.08, 4.10]) on the VAS. However, CL-SCS outperformed Paddle-SCS on the NRS, with SMDs of 4.39 vs 2.35, respectively. For 50% pain relief, Paddle-SCS had a success rate of 41.4%, as opposed to 35.4% for CL-SCS. Paddle-SCS showed a lower migration rate (4.3% vs 7.2% for CL-SCS) but higher infection rates (5.0% vs 3.3%).</div></div><div><h3>Conclusions</h3><div>Paddle-SCS offers superior pain reduction (as measured by the VAS) and a lower migration rate, but a higher infection risk compared with CL-SCS. CL-SCS showed better outcomes as measured by the NRS. The choice between Paddle-SCS and CL-SCS should be individualized according to patient-specific factors and treatment goals. Further research with rigorous study designs is needed to provide clearer comparisons between these interventions.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 204-233"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Stimulation Implantation Combining Ultrasound With Microendoscopy for Management of Chronic Neuropathic Pain: A Case Series Study","authors":"Bénédicte Bouche MD ,&nbsp;Maxime Billot PhD ,&nbsp;Arthur Voratanouvong MD ,&nbsp;Amine Ounajim PhD ,&nbsp;Maarten Moens MD, PhD ,&nbsp;Lisa Goudman PT, PhD ,&nbsp;Sam Eldabe MD ,&nbsp;Denys Fontaine MD, PhD ,&nbsp;Manon Duraffourg MD ,&nbsp;Manuel Roulaud MSc ,&nbsp;Kévin Nivole MSc ,&nbsp;Mathilde Many MSc ,&nbsp;Sandrine Baron RN ,&nbsp;Bertille Lorgeoux MSc ,&nbsp;Lucie Lampert MSc ,&nbsp;Romain David MD ,&nbsp;Philippe Rigoard MD, PhD","doi":"10.1016/j.neurom.2024.10.013","DOIUrl":"10.1016/j.neurom.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral nerve stimulation (PNS) has emerged as a minimally invasive percutaneous procedure addressing neuropathic pain. However, the percutaneous cylindrical lead ultrasound-guided implantation procedure requires expertise that limits widespread PNS utilization. To overcome these challenges, a microinvasive endoscopy device has very recently been developed, enhancing the precision of PNS implantation by providing accurate visualization of the targeted nerve. We aimed to determine the feasibility, safety, clinical effectiveness, and energy consumption of PNS therapy by means of ultrasound guidance combined with microendoscopy.</div></div><div><h3>Materials and Methods</h3><div>This is a retrospective, single-center, single-arm study. Patient recruitment was performed in February and March 2023. Patients with &gt;12 months of upper or lower limb pain presenting with pain &gt;5 of 10 that was refractory to conventional treatments were eligible. Safety was assessed by collecting adverse events and complications related to the PNS implantation with microendoscopy. The Multidimensional Clinical Response Index (MCRI), pain intensity (visual analog scale [VAS]), pain surface (PRISMap Software, PRISMATICS lab, CHU de Poitiers, Poitiers, France), quality of life (EuroQoL 5 dimensions 5 levels [EQ5D-5L]), functional disability (Oswestry Disability Index [ODI]), anxiety and depression (Hospital Anxiety and Depression Scale), and energy consumption were assessed at baseline and at one and three months.</div></div><div><h3>Results</h3><div>Six patients received PNS, which was implanted through ultrasound guidance combined with microendoscopy. No adverse event was reported during the three-month follow-up. Clinical outcomes (MCRI, VAS, ODI, EQ5D-5L) significantly increased at one- and three-month follow-up. Energy consumption was, on average, 2.6 ± 1.1 μC.s⁻¹ at one-month and 3.3 ± 2.0 μC.s⁻¹ at three-month follow-up.</div></div><div><h3>Conclusions</h3><div>Implanted PNS by means of ultrasound combined with microendoscopy was safe and provided clinical benefits with very low energy consumption (15–440 times less than spinal cord stimulation) in patients with upper or lower limb neuropathic pain. Microendoscopy would offer extended PNS indications, overcoming limitations associated with ultrasound alone. Future research is nonetheless needed to provide stronger evidence through randomized controlled trial design.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 2","pages":"Pages 274-282"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}