The use of spinal cord stimulation with overlaying areas of concentration and novel cathode anode combinations to control

l paresthesia shaping for optimal pain management.

Jack Schwartz and Todd Whitehurst MD

Stimwave Technologies, Scottsdale, Arizona Sensors for Medicine and Science, Inc. Germantown, MD
Introduction
Achieving optimal treatment with SCS is contingent upon effective programming which creates a concentrated area of paresthesia overlapping the region of pain. Selection of anode cathode combinations attempt to create paresthesia in the area of predominant pain. In difficult cases such as mechanical/ neuropathic pain in the lumbar region these basic anode cathode combinations fail to recruit the appropriate nerve fibers in an isolated fashion to provide effective relief.

Results
Of the 22 postlaminectomy patients with a predominance of lumbar region pain 17 utilized programs 1 and 3 for over 90 % of their total stimulation . The 17 specific patients noted increased pain relief, that was site specific .

Conclusion
Novel programming of anodes and cathodes beyond the traditional double guarded cathodes can be effective for patients who require elegant and sophisticated lead combinations. Multiple areas of concentration when appropriately combined offer unique contained, concentrated areas of stimulation to recruit specific dermatomes for pain control.

Methods
22 patients were implanted at the T 9 region with an epidural SCS system with 2 each eight contact leads to control their postlaminectomy pain primarily of low back concentration. 4 patients were implanted at the C1,C2 cervical region for radicular arm and hand pain, and one patient was implanted with dual leads for post herpetic neuralgia in the chest. All of the patients reported less than satisfactory results with their systems and sought continual reprogramming to establish consistent paresthesia in the region of pain. To enhance consistent , elegant paresthesia to overlap the various regions of pain a sophisticated pattern using novel anode-cathode combinations were utilized. Specific combinations of anodes and cathodes with varying balances of current can enhance and tightly shape the region of paresthesia, recruit specific nerves and allow for a highly concentrated region of stimulation. To further enhance this novel combination of electrode selection, 3 or 4 separate areas of concentration were created and combined into one program. Each patient was provided with two each such multiple areas of concentrations . These multiple areas of concentration with novel anode cathode combinations to enhance paresthesia were set into the patients remote control unit as program #1 and #3. Programs #2 and # 4 were traditional settings of anodes and cathodes such as double guarded cathodes.

RESEARCH POSTER PRESENTATION DESIGN 2012

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