Managing Chronic Pain with Implantable Therapies

New implantable technologies have improved the management of patients with chronic pain. During an afternoon session at the 2013 American Academy of Pain Medicine annual meeting, held April 12-14 in Fort Lauderdale, Florida, moderated by Timothy R. Deer, MD, of the Interventional Pain Management Center for Pain Relief in Charleston, WV, physicians highlighted new implantable therapies including spinal cord stimulation (SCS) of the dorsal root ganglion (DRG) and high frequency SCS.

During the session, Robert Levy, MD, of the University of Florida in Jacksonville, FL, discussed the effectiveness and safety of SCS of the DRG and peripheral nerve stimulation. DRG provides a unique target for stimulation, as it is located in a predictable location and provides subgangular specificity. In addition, DRG provides broad coverage or very specific coverage depending on the electric field, as there appears to be significant divergence and convergence with the target. Levy discussed the results of a feasibility study that demonstrated pain relief associated with SCS of the DRG. In addition, a larger study demonstrated that targeting SCS of the DRG showed significant decreases in pain. Other positive impacts included improvements in brief pain index (BPI), mood, and quality of life improvements. Overall, SCS of the DRG is a promising approach for the treatment of chronic low back pain.

Deer further expanded on implanted devices for pain relief by highlighting data that supports the use of these devices. The PROCESS study demonstrated that the use of SCS was effective in reducing chronic pain. In a follow-up study, the durability of SCS was demonstrated as well as improvements in quality of life parameters. Other data presented demonstrated that SCS showed improvements in chronic pain as compared to opioid use and reoperation. The most compelling data presented was on military personnel with complex regional pain syndrome (CRPS), as 5 of the 10 military personnel studied returned to active duty after treatment with SCS for their condition.

Deer also talked about newer technologies including percutaneous paddles and multi-lead delivery systems. He also touched on SCS of the DRG and occipital nerve stimulation.

In the last presentation of the session, Leonardo Kapural, MD, PhD, of Wake Forest Baptist Health in Winston Salem, NC, discussed new advances in SCS and highlighted the use of high-frequency stimulation. New advances in SCS include high-frequency stimulation, SCS of the DRG, and multi-lead delivery systems. Kapural discussed the efficacy and safety of high-frequency SCS and discussed the results of initial studies, demonstrating the effectiveness of the approach in small patient populations. He presented three clinical cases that benefited from the use of high-frequency SCS. Kapural concluded that high-frequency SCS is an advance in the treatment of chronic pain and is a promising option that may provide patients with longer lasting pain relief. Ongoing investigation of this approach is warranted based on early studies as well as clinical case reports.