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INTRODUCTION

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Spinal cord stimulation (SCS) offers hope to the estimated 75 million people who suffer from chronic pain. SCS sends electrical impulses that trigger nerve fibers selectively in the dorsal column based on the “gate control” theory. This interruption of pain signals traveling to the cerebral cortex causes feelings of pleasant and soothing tingling and paresthesia replacing the painful sensation of pain. Most commonly, SCS is utilized for the treatment of chronic neuropathic pain of the back, trunk, or extremities. Specifically these conditions include postlaminectomy syndrome, complex regional pain syndrome, diabetic neuropathy, as well as other off label uses have had great success with the SCS. SCS has successfully relieved pain in thousands of patients with severe chronic painful conditions.

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Neuroaugmentation techniques have become increasingly popular in the specialty of interventional pain medicine due to its wide variety of on-label and off-label applications. Most products are manufactured by Medtronic, St. Jude Medical, and Boston Scientific, and have been undergoing continuous evolution. Competition and innovation in the industry has led to advanced technology allowing for variable programming and smaller sizes to make it physically acceptable to patients. For example, the old leads with 4 electrodes, also known as contacts, have been replaced by leads with 8 electrodes. Currently, predominantly cylindrical leads are used for percutaneous trials and paddle leads for laminectomy procedures. Now thinner paddle (surgical) leads, previously implanted exclusively with a laminotomy and surgery, are now being implanted percutaneously. Although the basic device works on the principles of the “gate control” theory, each company offers products with unique advantages.

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The advantages of SCS therapy include:

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  • It is a nonpharmacologic option to control chronic pain.

  • By avoiding medications, there are no psychosocial or medicolegal implications related to drug abuse, addiction, or tolerance.

  • The system is reversible and can be removed without any harm to the patients, unlike spine surgeries that cannot be reversed.

  • The SCS can be programmed based on the chronic pain severity and location of pain.

  • Patient has ability to use multiple programs as desired for different situations, including fully turning a device off or on.

  • As pain location, quality, or characteristics may change, there is an opportunity for regulation of electrodes to adapt to lead migration, or new location and quality of pains.

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INDICATIONS FOR SCS

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Chronic, intractable pain of the trunk and/or limbs, including unilateral or bilateral pain associated with various conditions.

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On-label indications are:

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  • Failed back syndrome (FBS) or low back syndrome or failed back

  • Radicular pain syndrome or radiculopathies resulting in pain secondary to herniated disk

  • Degenerative disk disease (DDD) refractory to conservative and surgical interventions

  • Complex regional pain syndrome (CRPS) I or RSD

  • Complex regional pain syndrome II or causalgia

  • Epidural fibrosis

  • Arachnoiditis

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Off-label indications are:

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  • Extremity pain due to ischemia

  • Angina resistant to other therapies

  • Chronic headache not ...

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