According to the International Neuromodulation Society, neuromodulation is the alteration of nerve activity through targeted delivery of a stimulus, electrical or chemical. Applications in use today include electrical nerve stimulation, intrathecal drug delivery, transcranial magnetic stimulation, deep brain stimulation, etc.
In terms of interventional chronic pain therapies using neuromodulation, implanted spinal cord stimulators (SCS) and intrathecal drug delivery pumps (IDDP), are the most commonly utilized devices. The decision of which device to use will play a large part in the patient's therapeutic success. However, with advances in SCS outpacing those in IDDP therapies , intrathecal therapies have seemingly been reserved for stimulation failures.
In a study by Mekhail et al, a predictive formula was devised to predict analgesic success with SCS. A value x is obtained from x=(-0.064*age)+(-0.743*1 if male, 0 if female)+(0.486*1 if clinically depressed, 0 if not clinically depressed)+(0.681*1 if neuropathic pain exists, 0 if absent)+(0.468*1 if post-laminectomy syndrome exists, 0 if none)+(-0.678*1 if spine-related pain exists, 0 if none). Once x is calculated, it is entered into p, where p is the probability of success with SCS. P=e^x/(1+e^x), where e is Euler's number (2.718). Anyone with a value higher than 0.880 has a higher probability of success with a SCS than with IDDP therapy.
Mekhail N, Mehanny DS, Armanyous S, et al. Choice of spinal cord stimulation versus targeted drug delivery in the management of chronic pain: a predictive formula for outcomes [published online ahead of print, 2020 Jan 12]. Reg Anesth Pain Med. 2020;rapm-2019-100859. doi:10.1136/rapm-2019-100859.
In terms of interventional chronic pain therapies using neuromodulation, implanted spinal cord stimulators (SCS) and intrathecal drug delivery pumps (IDDP), are the most commonly utilized devices. The decision of which device to use will play a large part in the patient's therapeutic success. However, with advances in SCS outpacing those in IDDP therapies , intrathecal therapies have seemingly been reserved for stimulation failures.
In a study by Mekhail et al, a predictive formula was devised to predict analgesic success with SCS. A value x is obtained from x=(-0.064*age)+(-0.743*1 if male, 0 if female)+(0.486*1 if clinically depressed, 0 if not clinically depressed)+(0.681*1 if neuropathic pain exists, 0 if absent)+(0.468*1 if post-laminectomy syndrome exists, 0 if none)+(-0.678*1 if spine-related pain exists, 0 if none). Once x is calculated, it is entered into p, where p is the probability of success with SCS. P=e^x/(1+e^x), where e is Euler's number (2.718). Anyone with a value higher than 0.880 has a higher probability of success with a SCS than with IDDP therapy.
Mekhail N, Mehanny DS, Armanyous S, et al. Choice of spinal cord stimulation versus targeted drug delivery in the management of chronic pain: a predictive formula for outcomes [published online ahead of print, 2020 Jan 12]. Reg Anesth Pain Med. 2020;rapm-2019-100859. doi:10.1136/rapm-2019-100859.
