| Pulse width programming in spinal cord stimulation: a clinical study. | |
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MedLine Citation:
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PMID: 20648201 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: With advances in spinal cord stimulation (SCS) technology, particularly rechargeable implantable, patients are now being offered a wider range of parameters to treat their pain. In particular, pulse width (PW) programming ranges of rechargeable implantable pulse generators now match that of radiofrequency systems (with programmability up to 1000 microseconds. The intent of the present study was to investigate the effects of varying PW in SCS. OBJECTIVE: To understand the effects of PW programming in spinal cord stimulation (SCS). DESIGN: Single-center, prospective, randomized, single-blind evaluation of the technical and clinical outcomes of PW programming. SETTING: Acute, outpatient follow-up. METHODS: Subjects using fully-implanted SCS for > 3 months to treat chronic intractable low back and/or leg pain. Programming of a wide range (50-1000 microseconds) of programmed PW settings using each patient's otherwise unchanged 'walk-in' program. OUTCOME MEASURES: Paresthesia thresholds (perception, maximum comfortable, discomfort), paresthesia coverage and patient choice of tested programs. RESULTS: We found strength-duration parameters of chronaxie and rheobase to be 295 (242 - 326) microseconds and 2.5 (1.3 - 3.3) mA, respectively. The median PW of all patients' 'walk-out' programs was 400 microseconds, approximately 48% higher than median chronaxie (p = 0.01), suggesting that chronaxie may not relate to patient-preferred stimulation settings. We found that 7/19 patients selected new PW programs, which significantly increased their paresthesia-pain overlap by 56% on average (p = 0.047). We estimated that 10/19 patients appeared to have greater paresthesia coverage, and 8/19 patients appeared to display a 'caudal shift' of paresthesia coverage with increased PW. LIMITATIONS: Small number of patients. CONCLUSIONS: Variable PW programming in SCS appears to have clinical value, demonstrated by some patients improving their paresthesia-pain overlap, as well as the ability to increase and even 'steer' paresthesia coverage. |
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Authors:
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Thomas L Yearwood; Brad Hershey; Kerry Bradley; Dongchul Lee |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Pain physician Volume: 13 ISSN: 2150-1149 ISO Abbreviation: Pain Physician Publication Date: 2010 Jul-Aug |
Date Detail:
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Created Date: 2010-07-21 Completed Date: 2011-03-14 Revised Date: 2011-07-06 |
Medline Journal Info:
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Nlm Unique ID: 100954394 Medline TA: Pain Physician Country: United States |
Other Details:
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Languages: eng Pagination: 321-35 Citation Subset: IM |
Affiliation:
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Comprehensive Pain and Rehabilitation, Pascagoula, MS 39581, USA. nopaindr@mac.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Electric Stimulation Therapy
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adverse effects,
methods* Electrodes, Implanted / standards Female Humans Low Back Pain / therapy* Male Middle Aged Outcome Assessment (Health Care) / methods Pain Measurement / methods Paresthesia / etiology, prevention & control Prospective Studies Prosthesis Implantation / instrumentation, methods* Sciatica / therapy* Single-Blind Method Software* / standards Spinal Cord / surgery* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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