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HAND x 2021 UCLA Brain Awareness Week

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Spinal Cord Stimulation

By Max Orr, Alex Wu, and Daniel Hong
December 6th, 2020


Spinal Cord Stimulation Overview

What is Spinal Cord Stimulation (SCS)? SCS is a means of alleviating chronic pain in patients by stimulating spinal cord nerve fibers. These electrical impulses help inhibit pain signals that are sent to the brain. This form of treatment, previously questioned by many pain specialists about its safety and efficacy, has recently begun to make a comeback in being an effective, alternative treatment after exhausting other noninvasive forms of treatment. The patient will generally have a surgically implanted device, consisting of a battery pack and electrodes, that delivers electrical impulses to the spinal nerves blocking pain signals.


With a steady growth of chronic pain patients over the years, the need for SCS has also risen. SCS has been shown to deliver therapeutic results to patients: the sympatholytic effect. More specifically, this type of effect plays a major role in downplaying the activity of the sympathetic nervous system, thus decreasing the chronic pain experienced by the patient. Generally, SCS will be offered for patients experiencing failed back surgeries, neuralgia, neuropathy, and phantom limb pain. Ultimately, SCS improves a patient’s sleep patterns, quality of life, and reduces the need for ingested pain medicines.


Spinal Cord Stimulation in Chronic Pain

Spinal cord stimulation currently serves as an intervention for chronic back and leg pain, especially should other therapies fail to adequately manage these issues on their own. Using stimulators and electrical signals, pain signals for chronic conditions can be inhibited before they are registered by the brain.


Generally speaking, applications of SCS towards chronic pain involve a neurostimulator as a power source and sets of wires and electrodes to effectively deliver electrical pulses to the stimulation site at the spinal cord. Such pulses are now adjustable in amplitude, frequency, and duration, allowing the implementation of SCS to be tailored to the specific conditions of each individual patient. Furthermore, recent developments have allowed for outputs to be more precise in location and timing, and with such tools, SCS is targeted to only inhibit the pain signals it intends to alleviate for the patient without interrupting other signals the body routinely sends.


As a field, SCS is still rapidly evolving, with research being invested into increasing battery life and reliability, or developing less invasive methods for implantation. Development of increasingly accurate sensors is also a field of investigation. However, though SCS is a promising pain relief technology with many potential applications in chronic conditions, it is currently a novel and last-resort therapy used following attempts to control pain through more traditional means. The frequency of SCS application is expected to increase as the technology matures.


Spinal Cord Stimulation in Parkinson's

For Parkinson’s patients who’ve gone through deep brain stimulation (DBS) -- one of the well-known methods of reducing Parkinson’s Disease -- and had ineffective outcomes, SCS has recently been shown to decrease pain and reduce motor symptoms. Furthermore, other drug-treatment resistant patients also reported a decrease in pain after SCS.


Spinal Cord Stimulation, as mentioned before, is an invasive treatment, meaning the treatment goes inside the body. It plants electrodes near the patients’ spines and stimulates the electrodes in either continuous, on-off bursts, or continuous bursts of varying intensities. These bursts and intensities are then programmed depending on the patient for treatment.


According to a study by Chakravarthy et al., 2020, When SCS was performed on 15 patients: 100% reported a pain reduction of an average reduction of pain being 59%. Furthermore, 73% of the patients experienced an improvement of 12% in the 10 meter walk test -- a common test to analyze the physical mobility of Parkinson's patients, while 64% of the patients experienced improvements of around 21% in the Timed Up and Go test--another test to analyze physical balance and stability.


However, as with most treatment options, SCS also has its own side effects such as jolting, infection, seroma, and hematoma. Furthermore, it should be noted that as of current, no determination has been made on whether SCS should be used as a main, on-the-side, or last ditch method of treatment; it is effective and has the potential to fit in any of the 3 categories.


References


Vannemreddy, P., & Slavin, K. (2011). Spinal cord stimulation: Current applications for treatment of chronic pain. Anesthesia: Essays and Researches, 5(1), 20. https://doi.org/10.4103/0259-1162.84174


“Spinal Cord Stimulation - About.” Medtronic, 2019, www.medtronic.com/us-en/healthcare- professionals/therapies-procedures/neurological/spinal-cord-stimulation/education-training/about-the-therapy.html.


Hegarty, Dominic. "Spinal Cord Stimulation: The Clinical Application of New Technology." Anesthesiology Research and Practice, vol. 2012, Article ID 375691, 5 pages, 2012. https://doi.org/10.1155/2012/375691


Chakravarthy, K.V., Chaturvedi, R., Agari, T. et al. Single arm prospective multicenter case series on the use of burst stimulation to improve pain and motor symptoms in Parkinson’s disease. Bioelectron Med 6, 18 (2020) https://doi.org/10.1186/s42234-020-00055-3