Clinical Utilization of Fast-acting Sub-perception Therapy (FAST) in SCS-implanted Patients for Treatment of Mixed Pain

Overview

Journal Interv Pain Med

Date 2024 Sep 6

PMID 39238875

Authors

Georgios Matis

Lilly Chen

Roshini Jain

Que Doan

Affiliations

Soon will be listed here.

Abstract

Objectives: A significant proportion of patients with chronic pain exhibit mixed pain and thus do not display symptoms exclusively associated with either nociceptive or neuropathic pain syndromes. We aimed to explore whether Fast-Acting Sub-Perception Therapy, FAST - a new Spinal Cord Stimulation (SCS)-based approach capable of inducing a rapid-onset of analgesia using electrical neurostimulation applied below patient-perception threshold - could potentially be useful as a treatment for chronic mixed pain.

Methods: Fourteen consecutively-enrolled patients diagnosed with chronic mixed pain and implanted with an SCS device were enrolled in this single-center case-series. All patients completed a validated, self-administered painDETECT questionnaire prior to SCS-device implantation (baseline). The painDETECT questionnaire was used to characterize each patient's chronic pain as likely neuropathic only, uncertain (but potential for presence of a non-neuropathic component), or likely presence of a non-neuropathic component. Overall pain scores (Numeric Rating Scale, NRS), Oswestry Disability Index (ODI) and Quality-of-life (EQ-5D-5L) were collected (per standard-of-care) at baseline, 3-months, and 6-months post-implantation.

Results: The average age of those assessed in this study was 64.7 ± 11.5 (SD) years and 43% (6/14) were female. Fifty-percent (7/14) of patients were classified with non-neuropathic pain (painDETECT), while the remainder exhibited chronic pain that could not be characterized as either neuropathic or non-neuropathic (uncertain). Mean overall pain (NRS) among all patients was 8.3 ± 0.3 (SE) at baseline. At 6-months post-implant, a mean 6.9-points NRS score reduction was observed (1.4 ± 0.3 (SE); p < 0.0001). Notable improvements in disability (ODI) and Quality of Life (EQ-5D-5L) were also observed at 6-month follow-up.

Conclusions: The data from this observational case-series indicate that FAST-SCS can improve outcomes in patients reporting complex symptoms of mixed pain with a likely non-neuropathic component. These results suggest that neurostimulation modalities such as FAST may be a suitable treatment approach for non-neuropathic pain indications.

References

Veizi E, Hayek S, North J, Brent Chafin T, Yearwood T, Raso L . Spinal Cord Stimulation (SCS) with Anatomically Guided (3D) Neural Targeting Shows Superior Chronic Axial Low Back Pain Relief Compared to Traditional SCS-LUMINA Study. Pain Med. 2017; 18(8):1534-1548. DOI: 10.1093/pm/pnw286. View

Thomson S, Tavakkolizadeh M, Love-Jones S, Patel N, Gu J, Bains A . Effects of Rate on Analgesia in Kilohertz Frequency Spinal Cord Stimulation: Results of the PROCO Randomized Controlled Trial. Neuromodulation. 2017; 21(1):67-76. PMC: 5814855. DOI: 10.1111/ner.12746. View

Gudbergsen H, Bartels E, Krusager P, Waehrens E, Christensen R, Danneskiold-Samsoe B . Test-retest of computerized health status questionnaires frequently used in the monitoring of knee osteoarthritis: a randomized crossover trial. BMC Musculoskelet Disord. 2011; 12:190. PMC: 3176488. DOI: 10.1186/1471-2474-12-190. View

Fairbank J, Pynsent P . The Oswestry Disability Index. Spine (Phila Pa 1976). 2000; 25(22):2940-52; discussion 2952. DOI: 10.1097/00007632-200011150-00017. View

Lee A, Pilitsis J . Spinal cord stimulation: indications and outcomes. Neurosurg Focus. 2007; 21(6):E3. DOI: 10.3171/foc.2006.21.6.6. View

Dones I, Levi V . Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications. Brain Sci. 2018; 8(8). PMC: 6119923. DOI: 10.3390/brainsci8080138. View

Joosten E, Franken G . Spinal cord stimulation in chronic neuropathic pain: mechanisms of action, new locations, new paradigms. Pain. 2020; 161 Suppl 1:S104-S113. PMC: 7434213. DOI: 10.1097/j.pain.0000000000001854. View

Bordeleau M, Cottin S, Meier K, Prudhomme M . Effects of Tonic Spinal Cord Stimulation on Sensory Perception in Chronic Pain Patients: A Systematic Review. Neuromodulation. 2018; 22(2):149-162. DOI: 10.1111/ner.12893. View

Coghill R . The Distributed Nociceptive System: A Framework for Understanding Pain. Trends Neurosci. 2020; 43(10):780-794. PMC: 7530033. DOI: 10.1016/j.tins.2020.07.004. View

10.

Al-Kaisy A, Palmisani S, Smith T, Harris S, Pang D . The use of 10-kilohertz spinal cord stimulation in a cohort of patients with chronic neuropathic limb pain refractory to medical management. Neuromodulation. 2014; 18(1):18-23. DOI: 10.1111/ner.12237. View

11.

Zhang T, Janik J, Grill W . Mechanisms and models of spinal cord stimulation for the treatment of neuropathic pain. Brain Res. 2014; 1569:19-31. DOI: 10.1016/j.brainres.2014.04.039. View

12.

Schlereth T, Magerl W, Treede R . Spatial discrimination thresholds for pain and touch in human hairy skin. Pain. 2001; 92(1-2):187-94. DOI: 10.1016/s0304-3959(00)00484-x. View

13.

Matsubayashi Y, Takeshita K, Sumitani M, Oshima Y, Tonosu J, Kato S . Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. PLoS One. 2013; 8(9):e68013. PMC: 3787034. DOI: 10.1371/journal.pone.0068013. View

14.

Yeop Lee K, Bae C, Lee D, Kagan Z, Bradley K, Chung J . Low-intensity, Kilohertz Frequency Spinal Cord Stimulation Differently Affects Excitatory and Inhibitory Neurons in the Rodent Superficial Dorsal Horn. Neuroscience. 2020; 428:132-139. DOI: 10.1016/j.neuroscience.2019.12.031. View

15.

Janig W, Spencer W, Younkin S . Spatial and temporal features of afferent inhibition of thalamocortical relay cells. J Neurophysiol. 1979; 42(5):1450-60. DOI: 10.1152/jn.1979.42.5.1450. View

16.

Mulvey M, Boland E, Bouhassira D, Freynhagen R, Hardy J, Hjermstad M . Neuropathic pain in cancer: systematic review, performance of screening tools and analysis of symptom profiles. Br J Anaesth. 2017; 119(4):765-774. DOI: 10.1093/bja/aex175. View

17.

Freynhagen R, Parada H, Calderon-Ospina C, Chen J, Emril D, Fernandez-Villacorta F . Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin. 2018; 35(6):1011-1018. DOI: 10.1080/03007995.2018.1552042. View

18.

Lindblom U, Meyerson B . Influence on touch, vibration and cutaneous pain of dorsal column stimulation in man. Pain. 1975; 1(3):257-270. DOI: 10.1016/0304-3959(75)90042-1. View

19.

Shealy C, Mortimer J, HAGFORS N . Dorsal column electroanalgesia. J Neurosurg. 1970; 32(5):560-4. DOI: 10.3171/jns.1970.32.5.0560. View

20.

Quevedo A, Morch C, Andersen O, Coghill R . Lateral inhibition during nociceptive processing. Pain. 2017; 158(6):1046-1052. PMC: 5435538. DOI: 10.1097/j.pain.0000000000000876. View