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Introduction: Spinal cord stimulation (SCS) is an efficacious chronic pain treatment most commonly used in middle-aged patients. Results from previous studies that investigated SCS' effects in older patient populations have been equivocal. We examine whether SCS outcomes correlate with age., Methods: We retrospectively examined prospectively collected outcomes from 189 patients who underwent SCS at Albany Medical Center between 2012 and 2020. The patients completed the Numerical Rating Scale (NRS), McGill Pain Questionnaire (MPQ), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) preoperatively and 1 year postoperatively. The mean percent change in each outcome was determined and compared via a regression analysis to determine relationships between patient age and each respective outcome metrics. Demographics were compared between patients aged under 65 versus those aged 65 and older via χ2 tests., Results: All subjects demonstrated the expected improvement on NRS, BDI, PCS, and MPQ from baseline to 1-year follow-up, with several demonstrating statistically significant changes: NRS-worst pain (18.66%, p < 0.001), NRS-least pain (26.9%, p < 0.001), NRS-average pain (26.9%, p < 0.01), NRS-current pain (26.4%, p < 0.001), ODI (19.6%, p < 0.001), PCS (29.8%, p < 0.001), and MPQ (29.4%, p < 0.001). There was no significant difference between patients aged under 65 versus those aged 65 and older based on lead type (p = 0.454). Six patients (3.1%) had lead migration, one of whom was 65 or older. Regression analysis revealed improvements in MPQ-sensory and MPQ-affective scores as age increased (p < 0.001, R2 = 0.09; p = 0.046, R2 = 0.05, respectively). Age did not correlate with NRS, ODI, BDI, or PCS. Diagnosis, spinal level of SCS, and lead type were not found to influence any respective outcome measure based on covariate analysis., Conclusion: This study represents the largest study where age was correlated to specific pain, depression, and disability outcomes following SCS. We provide evidence that SCS outcomes are equivalent, or better, in older patients following SCS. Based on these findings, SCS is a viable option for treatment of chronic pain in elderly patient populations., (© 2021 S. Karger AG, Basel.)

Objective: To conduct a systematic literature review of brain neurostimulation for pain., Design: Grade the evidence for deep brain neurostimulation (DBS)., Methods: An international, interdisciplinary work group conducted a literature search for brain stimulation. Abstracts were reviewed to select studies for grading. Randomized controlled trials (RCTs) meeting inclusion/exclusion criteria were graded by two independent reviewers. General inclusion criteria were prospective trials (RCTs and observational) that were not part of a larger or previously reported group. Excluded studies were retrospective or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the United States Preventative Services Task Force level-of-evidence criteria., Results: Two high-quality RCTs and three observational trials supported DBS, resulting in Level II (moderate) evidence., Conclusion: Moderate evidence supports DBS to treat chronic pain. Additional Level I RCTs are needed to further the strength of the evidence in this important area of medicine, but the current evidence suggests that DBS should be considered as an option in treating complex pain cases., (© 2020 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To investigate the differences in neural patterns between spinal cord stimulation (SCS) waveforms (60-Hz tonic vs 10-KHz high frequency stimulation, HFS) and their correlation to stimulation-induced pain relief., Methods: We recorded 10-channel electroencephalogram (EEG) in response to stimulation ON and OFF in 9 chronic pain patients (4 women, 5 men) during SCS surgery and examined the intraoperative spatio-spectral EEG features., Results: We discovered stronger relative alpha power in the somatosensory region and higher trend in alpha/theta peak power ratio in frontal cortex with HFS. We also observed a shift in peak frequency from theta to alpha rhythms in HFS as compared to baseline and tonic stimulation, where slower theta activity was maintained. Further, a positive correlation was found between changes in Oswestry disability index (ODI) scores (from preoperative to postoperative) and HFS-induced alpha/theta peak power ratio in frontal and somatosensory regions., Conclusions: Altogether, our findings suggest that dynamic spectral interactions in theta-alpha band and their spatial distributions might be the first intraoperative neural signatures of pain relief induced by HFS in chronic pain., Significance: Examining electrophysiological changes intraoperatively has a potential to elucidate response to SCS therapy prior to device selection, reducing the healthcare expenditures associated with failed implants., Competing Interests: Declaration of Competing Interest Dr. Pilitsis is a consultant for Boston Scientific, Nevro, TerSera and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, TerSera, NIH 2R01CA166379-06, and NIH U44NS115111. She is the medical advisor for Aim Medical Robotics and Karuna and has stock equity. Steven Paniccioli, Rachael Grey, Michael Briotte, and Kevin McCarthy are employees of Nuvasive., (Copyright © 2020 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Background: Spinal cord stimulation (SCS) is a known therapy for a variety of chronic pain conditions, but over time a number of patients proceed to explants., Objectives: We compared explant rates based on degree of pain relief, diagnosis, lead location, gender, and age to determine possible predictors for SCS implant success., Methods: First, we performed a single-center retrospective chart review of consecutive SCS-implanted subjects was to document internal explant rates. Rates of explants based on diagnosis, gender, age, and lead location were compared to determine potential trends. We then examined which thoracic SCS patients in our prospectively collected outcome measures data base who were explanted., Results: A total of 63 of 671 thoracic SCS were explanted. Thoracic explants occurred in patients who were significantly younger (p = 0.03). Women who were explanted reported significantly more discomfort from the device (p = 0.05). When we looked at our data base of patients with a mean time implanted of 2.77 years and a minimum of one year follow-up, 11 of 114 thoracic SCS patients were explanted. All explants were women. There was no correlation with diagnosis or age. Those who were explanted reported more pain (p = 0.03) and depression (p < 0.01) at one year follow-up., Conclusions: Our data correlates explants with less pain relief and more depression. Women are more likely to have explants than men. The role of physiologic and psychosocial variables leading to this difference has yet to be elucidated., (© 2019 International Neuromodulation Society.)