In an opening session presentation at PAINWeek 2018 in Las Vegas, Nevada, September 4-8, 2018, titled, "Electroceuticals: The Future of Interventional Pain Management?” the case was made for applying neuromodulation as a non-opioid and opioid-sparing intervention for chronic pain.
“Since the Roman Empire, electricity has been used in the field of medicine for treating pain,” indicated Sean Li, MD, Regional Medical Director and Partner, Premier Pain Centers, East Brunswick, New Jersey. “In the era of modern medicine, the field of neuromodulation has entered its renaissance with introduction of novel wave forms such as HF-SCS (high frequency spinal cord stimulation) at 10 kHz, burst closed loop, and noninvasive vagal nerve stimulation.
“This ripple effect has provided chronic pain patients with additional treatment options and challenged our current understanding of neurostimulation,” Li advised the session attendees.
That sentiment is increasingly expressed by those familiar with the technology, as reflected by a recent commentary in the journal Neuromodulation by Editor-in-Chief Robert Levy, MD, PhD. “With proven far better outcomes and profoundly fewer serious complications, neurostimulation, and not chronic opioids, is becoming a no brainer,” Levy wrote.
In a presentation later in PAINWeek, Li reported on a prospective trial that he conducted with colleagues to assess HF-SCS at 10 kHz in the treatment of chronic, intractable pain from peripheral polyneuropathy (PPN). They enrolled 26 subjects with chronic, intractable pain from PPN affecting an upper or lower limb. The average pain at baseline reported on a 0- to 10-cm visual analog scale was 8.2 ± 1.0 cm.
The subjects were implanted with 2 epidural leads spanning C2-C6 vertebral bodies for upper limb pain or T8-T11 for lower limb pain. After successful trial stimulation, each was implanted with a proprietary HF-SCS at 10kHz delivery device (Senza, Nevro), developed to produce spinal cord stimulation without paresthesia.