Chronic Treatment of Axial Back Pain with Spinal Cord Stimulation

Richard Rosenthal1 Lilly Chen2, Kerry Bradley2, Nitzan Mekel-Bobrov2

1Nexus

Pain Care, Provo, Utah. 2Boston Scientific Neuromodulation, Valencia, CA

Introduction
Spinal cord stimulation (SCS) has been successfully used to treat leg pain Long-term treatment of back pain has been considered difficult due to technical challenges of achieving and maintaining coverage of the low back. Modern stimulation technology has improved the likelihood of low back paresthesia coverage, thus enabling the assessment of SCS for chronic low back pain. We present our retrospective review of patients with predominant low back pain treated with SCS.

Results
N: 28 SCS patients with predominant axial low back pain were interviewed Gender: 16 Male / 12 Female Age: 61.713.5 (39 - 85) years-old Implant Duration: mean of 16.66.0 months postimplant. Pain Assessments: Patients achieved a clinically and highly statistically significant pain relief in their low back, with a mean of 5625% (P=<0.0001).

Methods
A researcher uninvolved in patient care conducted scripted telephone interviews with an inclusive, sequential series of patients implanted with Precision SCS systems (Boston Scientific, Valencia, CA) at a single pain management practice (Nexus Pain Care. Interview scripts captured multiple metrics of patient outcomes in different domains: Pain Assessments Medication Use Health Care Utilization Quality of Life Questions were directed for patient recall along different time periods: On day of interview During the previous month Comparison of time before SCS to time after SCS General questions about SCS use since implant Pain ratings and non-pain outcomes were tabulated.

Medications: Over half the patients showed a clinically significant reduction in opioid use (n=15)
Health Care Utilization: Over half made fewer painrelated doctor's visits (n=16). Quality of Life: almost all patients were: Better able to cope with the remaining pain (n=24), Reported a higher overall quality of life (n=22) Returned to work or hobbies (n=17).

Conclusions
In this prospective consecutive case-series we observed positive outcomes for patients with axial back pain, a location generally considered difficult to treat with SCS. Based on these outcomes and its minimally invasive and reversible nature, SCS may be an attractive treatment option for intractable low-back pain. Further controlled study is recommended.
Presented at: 6th World Congress of the World Institute of Pain, Miami Beach, FL, February 4-6, 2012. Study sponsored by Boston Scientific Corporation.