E-Poster Orals

EPV016 - HIGH FREQUENCY 10 KHZ SPINAL CORD STIMULATION FOR THE TREATMENT OF CHRONIC NEUROPATHIC PAIN RESULTING FROM SPINAL CORD INJURY (ID 245)

Session Name
E-Poster Orals
Presenter
  • Ashish Gulve, United Kingdom
Authors
  • Munawar Mecci, United Kingdom
  • Wunna Aung, United Kingdom
  • Sarah Griffiths, United Kingdom
  • Anisah Tariq, United Kingdom
  • Anu Kansal, United Kingdom
  • Angela Santos, United Kingdom
  • Sam Eldabe, United Kingdom
  • Ashish Gulve, United Kingdom
Presentation Number
EPV016
Presentation Topic
05a. Pain

Abstract

Introduction

Prevalence of spinal cord injury (SCI) is difficult to ascertain due to its multiple causes. In the UK alone, there are over 40,000 people living with SCI.1 One of the many complications of SCI is neuropathic pain.

Low-frequency spinal cord stimulation (SCS) has been used to treat pain in SCI patients, however, no sufficient evidence has been found to support its use.2 Case studies have shown promising results using 10 kHz SCS to treat neuropathic pain in SCI patients, including restored sensory and motor function in one patient.3,4 The goal of this prospective, feasibility study is to evaluate the safety and effectiveness of 10 kHz SCS for the alleviation of chronic neuropathic pain in patients with an incomplete or complete SCI.

Methods/Materials

Subjects with chronic, intractable pain of ≥5 cm (visual analogue scale, VAS) in a target pain area directly related to SCI were enrolled in a prospective, single-centre study. Other eligibility criteria consisted of injury at cervical/thoracic/lumbar/sacral level, the American Spinal Injury Association Impairment Scale (ASIA) of A-D and neuropathic pain. Subjects were trialled with 10 kHz SCS, those with a successful trial (≥50% pain relief) were implanted with a permanent system. Safety and effectiveness endpoints were captured up to 12 months post-implant.

Results

Per the latest analysis, 14 of the 21 enrolled subjects underwent a trial implant; scar tissue and fusion material precluded lead placement in 2 subjects and 7 had a successful trial (58% success rate). Data is available for 6 of the subjects with permanent implants.

The baseline mean (±SD) pain scores (all pain areas) of 8.1±1.5 cm (N=6) improved to 2.4±1.6 cm (N=6) at the end of trial. Pain scores remained improved at 2.7±1.8 cm (N=6), 3.2±3.0 cm (N=6), 5.4±2.7 cm (N=5), 2.6±2.2 cm (N=5) and 3.4±2.5 cm (N=5) at 1, 3, 6, 9 and 12 month post-implant follow-up, respectively. Beck Depression Index (BDI) and EQ-5D-5L health status and EQ-5D index score also improved (Graph 1 and 2). Two subjects were reclassified from ASIA A at baseline to ASIA B at their 3, 6 and 12-month visits due to improved sensory function.

sci e-ins.png

Discussion

Not applicable.

Conclusions

This study provides promising preliminary results for the use of 10 kHz SCS in SCI patients to treat their chronic pain. Additional outcomes captured suggest that there may be added benefits to this therapy including improvement in health and sensory function.

References

1 -Royal College of Physicians, British Society of Rehabilitation Medicine, Multidisciplinary Association of Spinal Cord Injury Professionals, British Association of Spinal Cord Injury Specialists, Spinal Injuries Association. Chronic spinal cord injury: management of patients in acute hospital settings: national guidelines. Concise Guidance to Good Practice series, No 9. London: RCP, 2008.

2 -Lagauche et al. The chronic neuropathic pain of SCI: which efficiency of neuropathic stimulations? Ann.Phy.Rehab.Med. 52 (2009) 180-187.

3 -Sisson et al. Sustained pain relief and functional improvement in SCI patients treated with HF-SCS at 10 kHz: Two Case reports. Abstract & Poster, NANS congress 2017.

4 -Verdolin. Restoration of sensory and motor function after acute trial stimulation in SCI with HF-SCS at 10kHz: a case report. Abstract & Poster, NANS congress 2017.

Hide