Maria Angeles Canós-Verdecho

Background and objective: Chronic painful peripheral polyneuropathy (PPN) is a leading global cause of chronic pain and may arise from a wide range of etiologies. When pharmacological treatments fail to provide adequate pain relief, spinal cord stimulation (SCS) has demonstrated efficacy in selected subtypes. This study investigated the effectiveness of SCS in alleviating pain, neurological symptoms and signs, and other health-related outcomes in patients with diverse forms of PPN, including diabetic (DPN) and chemotherapy-induced (CIPN) peripheral neuropathies, and chronic idiopathic axonal polyneuropathy (CIAP). Methods: This prospective, single-center observational study included 30 patients with drug-refractory PPN (11 DPN, 8 CIPN, 9 CIAP, and 2 other etiologies: 1 amyloidosis and 1 Fabry disease). All patients were implanted with two percutaneous leads at T10–T11 targeting lower limbs; a cervical lead (C4–C7) when upper limb pain was present; and SCS system. Low-frequency (p < 0.001) across all PPN subtypes, with greater improvements observed in DPN ( p < 0.001). Additional benefits included reductions in neuropathic symptoms (NPSI from 61.1 to 11.1; p < 0.001), autonomic symptoms (SAS from 16.5 to 9.9; p = 0.02) and improvements in sleep, functioning, and quality of life (EQ-VAS from 38.8 to 77.9; p < 0.001). Neurological signs remained unchanged. Use of analgesics decreased substantially (59% complete withdrawal; 41% partial), and 96% of patients reported “much” or “very much” improvement. Twelve-month IENFD measurements showed a lower-than-expected mean decline across etiologies, with IENFD increases outnumbering decreases, although the changes were modest. Discussion: SCS was associated with substantial and durable improvements in pain, neuropathic and autonomic symptoms, and other wellbeing outcomes across multiple painful PPN etiologies. The IENFD results suggest that SCS may have some effects on small-fiber integrity.

Background/Objectives: Over the last 20 years, spinal cord stimulation (SCS) has seen the development of various paresthesia-free paradigms. Recently, a novel modality has emerged (Fast-Acting Sub-perception Therapy, FAST) that engages the surrounding inhibition mechanism of action. We evaluated long-term, real-world outcomes of preferential FAST-SCS use in patients with chronic pain. Methods: In this multi-center, observational, consecutive case series, medical chart data from chronic pain patients preferentially using FAST-SCS (no exclusions) were retrospectively reviewed. Results: Data from 167 patients in 13 European centers were analyzed; 74% of patients suffered from persistent spine pain syndrome type 2 and 87% presented with low back and/or leg pain. At the last follow-up (mean 1.6 years), the numerical rating scale (NRS) overall pain score decreased by 5.1 ± 2.5 points versus baseline, from 8.0 ± 1.2 to 2.9 ± 2.2 (n = 167, p < 0.0001). 87% of patients reported ≥50% pain relief, and 55% were “high responders” with overall NRS pain scores ≤2/10. At the last follow-up, functional disability improved significantly (the Oswestry Disability Index reduced by 29.2 ± 21.5 points, n = 65, p < 0.0001) and patients had a significant gain in quality of life (EQ-5D-5L visual analog scale increased by 52.0 ± 26.9 points, n = 86, p < 0.0001). Results at the 2-year follow-up showed a sustained, substantial reduction in pain; 67% of patients were high responders and the NRS overall pain score decreased by 5.6 ± 2.4 versus baseline (n = 52, p < 0.0001). Conclusions: Our real-world outcomes suggest that in patients with chronic low back and/or leg pain, FAST-SCS therapy provided durable and profound pain relief and led to significant improvements in disability and quality of life.

Objective: To determine, using the Delphi method, standardized recommendations for the follow‐up of patients undergoing an interventional procedure for the treatment of chronic pain in Spain.Methods: First, a systematic literature review was performed to identify the literature on the management of patients with chronic pain undergoing interventional techniques; subsequently, a two‐round Delphi survey with 108 questions was conducted. The questionnaire was validated by a Scientific Committee (5 experts) and sent to 47 experts specialized in chronic pain. “Consensus” or “intermediate consensus” was determined when ≥ 75% or < 75% to ≥ 65% of the experts selected the same answer for each item, respectively. Then, a face‐to‐face deliberation process was held with the Scientific Committee to analyze and discuss the results.Results: The questionnaire was completed by 24 panelists (51%). Consensus was reached on 88.4% of the questions. The panelists identified pain, drug consumption, and quality of life as essential variables in the follow‐up of patients with chronic pain. Consensus was reached on most of the scales/questionnaires to be used in measuring outcomes during follow‐up, except for psychological status. Regarding the follow‐up frequency, in radicular spinal chronic pain, a consensus was reached on the first visit 1–2 months after the intervention, during the first year, at 1, 3, 6, and 12 months, and then every 6 months thereafter. For non‐radicular spinal chronic pain, the first visit 1–2 months after surgery was agreed upon, however, there was no consensus on follow‐up during the first year. For non‐spinal chronic pain, consensus was reached regarding the first visit at 1–2 months after surgery and during the first year at 1, 3, 6, and 12 months. No consensus was reached on follow‐up frequency for oncological chronic pain. After receiving a permanent neurostimulator implant for chronic pain, the first visit was agreed upon at 1–3 weeks, during the first year, at 2 weeks, 1, 3, 6, and 12 months, and after, every 6 months. For intrathecal infusion, it was agreed that the first visit should occur during the first month, and thereafter whenever the pump requires a refill.Conclusions: These findings provide recommendations in relation to the frequency of follow‐up and the scales to be used with chronic pain patients undergoing interventional techniques in Spain.

Aims: The aim of this study was to determine whether there exists a difference in efficacy in the treatment of lumbar radiculopathy with quantum molecular resonance coablative radiofrequency, and q... Tweetable abstract Preliminary evaluation of the efficacy of lumbar radiculopathy treatment with quantum molecular resonance coablative radiofrequency and microdiscectomy (QMRG) shows effectiveness...

Given the differing mechanisms thought to underlie therapeutic sub- and supra-perception-based neurostimulative modalities, Spinal Cord Stimulation (SCS) systems designed for combined delivery of these approaches may help improve analgesic outcomes and quality of life, and reduce treatment failures. This multicenter, observational case-series evaluated 188 patients with chronic back and/or leg pain implanted with an SCS device capable of sequential or simultaneous delivery of sub-perception and supra-perception stimulation programming (i.e., combination therapy) at 16 sites in Europe. Following implantation, patients were provided with an array of advanced supra-perception programs (e.g., paresthesia-based SCS using multiple independent current sources), and a custom set of sub-perception programs optimized with specific waveforms and/or field shapes. A mean overall pain score of 7.9 ± 1.7 (Standard Deviation (SD)) was reported pre-trial (Baseline). Overall pain was reduced by 4.4 ± 2.8 points (NRS) at 3-months (n = 117) and at 12 months post-implant (n = 90), respectively (p < 0.0001). Substantial quality-of-life (EQ-5D-5L) improvement as assessed at last follow-up was also observed (n = 60). These results suggest that an implanted SCS device capable of combination therapy, while also enabled with patient-specific waveform optimization and stimulation field targeting capabilities, can enable highly effective pain relief and improve quality of life in patients suffering with chronic pain.