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Spinal cord stimulation programming: a crash course

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Abstract

The aim of this comprehensive review is to provide an instructional guide for providers regarding the parameters and programming of spinal cord stimulation (SCS) devices. Knowing these fundamentals will aid in providing superior pain relief to patients. SCS has four programmable parameters: contact (electrode) selection, amplitude, pulse width, and frequency. Each parameter needs to be accounted for when assessing which program works for which patient. Traditional open-loop systems allow for different “programs,” or combinations of these four parameters, to be pre-set by the provider and medical device representative. These allow for flexibility in the type of stimulation delivered to the patient depending on activity. Patients are also given control over programs and changing the amplitudes of these programs. However, some open-loop systems place the burden of toggling between programs to manage pain control on patients, though this tends to be less in subparesthesia programs. Newer closed-loop systems make it possible for stimulation settings to automatically adjust in response to accelerometry and evoked compound action potential feedback, and therefore have the potential to streamline the patient experience. This article provides practitioners with the basic knowledge of SCS parameters and programming systems. Understanding their use is essential to providing optimal pain relief to patients.

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Acknowledgments

We would like to thank Liam McCarthy of Abbott for his guidance regarding basics of programming, and Michael Gillogly for his summary of clinical considerations.

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  1. Breanna Sheldon and Michael D. Staudt contributed equally to this work.

Authors and Affiliations

  1. Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Ave, MC 10, Physicians Pavilion, 1st Floor, Albany, NY, 12208, USA

    Breanna Sheldon, Lucian Williams & Julie G. Pilitsis

  2. Department of Neurosurgery, Albany Medical College, Albany, NY, USA

    Michael D. Staudt, Tessa A. Harland & Julie G. Pilitsis

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Correspondence to Julie G. Pilitsis.

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Dr. Pilitsis is a consultant for Boston Scientific, Nevro, TerSera, and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, TerSera, NIH U44NS115111, and NIH 2R01CA166379-06. She is a medical advisor for Aim Medical Robotics and Karuna and has stock equity. The remaining authors have no conflicts of interest to report.

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Sheldon, B., Staudt, M.D., Williams, L. et al. Spinal cord stimulation programming: a crash course. Neurosurg Rev 44, 709–720 (2021). https://doi.org/10.1007/s10143-020-01299-y

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