Lisa M. Johanek

Parameters of Spinal Cord Stimulation and Their Role in Electrical Charge Delivery: A Review.

All spinal cord stimulation (SCS) parameters (amplitude, pulse width, frequency) influence the interaction of stimulation with the nervous system and impact the delivery of charge. Regardless of the stimulation pattern, there are certain crucial elements related to dose, and a basic fundamental knowledge of the parameters used to administer the therapy is fundamentally important.

Assessment of Patient Preference for Constant Voltage and Constant Current Spinal Cord Stimulation

Objectives:  Spinal cord stimulation devices control energy by generating either constant voltage (CV) pulses or constant current (CC) pulses. This study aimed to investigate: 1) whether patients feel differences between CV and CC stimulation; 2) if patients prefer CV or CC stimulation.

Differential Effects of Subcutaneous Electrical Stimulation (SQS) and Transcutaneous Electrical Nerve Stimulation (TENS) in Rodent Models of Chronic Neuropathic or Inflammatory Pain

Electrical stimulation has been used for many years for the treatment of pain. Present‐day research demonstrates that stimulation targets and parameters impact the induction of specific pain‐modulating mechanisms. New targets are increasingly being investigated clinically, but the scientific rationale for a particular target is often not well established. This present study compares the behavioral effects of targeting peripheral axons by electrode placement in the subcutaneous space vs. electrode placement on the surface of the skin in a rodent model.

Assessment of Physical Activity of Patients With Chronic Pain

To define the key terms and concepts relating physical activity to chronic pain; to provide a brief overview of the various methods of assessment of physical activity; to review the current literature about physical activity and chronic pain; and to identify needs for future research.

Lack of Analgesic Synergy of the Cholecystokinin Receptor Antagonist Proglumide and Spinal Cord Stimulation for the Treatment of Neuropathic Pain in Rats: PROGLUMIDE DOES NOT ENHANCE ANALGESIA OF SCS

Neuropathic pain is difficult to manage and treat. Spinal cord stimulation (SCS) has become an established procedure for treating chronic neuropathic pain that is refractory to pharmacological therapy. In order to achieve better analgesia, a number of studies have evaluated the effectiveness of combining drug therapy with SCS. Cholecystokinin antagonists, such as proglumide, enhance the analgesic efficacy of endogenous opioids in animal models of pain. We previously reported that both systemic and spinal administration of proglumide enhances analgesia produced by both low‐ and high‐frequency transcutaneous electrical nerve stimulation (TENS). Since SCS produces analgesia through endogenous opioids, we hypothesized that the analgesic effect of SCS would be enhanced through co‐administration with proglumide in animals with neuropathic pain.

Chapter 17 – Programming – SCS

Publisher Summary This chapter focuses on the principles guiding the programming of spinal cord stimulation (SCS) devices. A main contributor to the successful treatment with SCS is accurate placement of electrodes to deliver current to the correct neural targets. Because SCS electrically excites these axons in the dorsal columns, a sensation of stimulation-induced paresthesia is detected by the patient. One challenge of SCS is that the electrodes and the neural targets of stimulation are separated by a distance primarily determined by the thickness of the dorsal cerebrospinal fluid layer (dCSF). While dCSF is the main determinant of the distance between the electrodes and dorsal columns, lead placement variability within the epidural space may also account for threshold differences between patients. In addition to proper anatomical targeting, successful SCS depends on properly set stimulation parameters. Modern neurostimulation devices provide a high degree of configurability of stimulation parameters. Different control technologies respond differently to changes in electrode–tissue impedance over time. Current controlled systems (CC) attempt to adjust their drive voltage to maintain a constant current output.