The algorithm for choice of optimal mode for spinal cord electrostimulation in treatment of chronic pain syndrome

Abstract

Objective: the development of algorithm for choice of optimal mode for spinal cord electrostimulation in treatment of indoor patients with chronic pain syndrome after implantation of epidural electrodes in area of interest corresponding to spinal segments functionally determined the localization of pain sense. Material and methods: This algorithm was developed for test device of Medtronic, USA while performing neurostimulation with the usage of 4-contact cylinder epidural electrode implantation. The base of algorithm included the following parameters: controlled choice of active contacts polarity, patient’s position, fixed values of duration and pulse repetition frequency as well as values of current amplitude. Results: the modes choice for chronic spinal cord electrostimulation was performed at 30 patients with refractory pain syndrome taking into account the developed algorithm. The sequence of operations reflected in presented algorithm allows reducing time for choice of optimal combination of chronic stimulation factors and minimizing the level of medical error while spontaneous prescription of certain stimulation mode for certain patient as well as determing the patient’s possibilities for evaluation of dynamics of pain syndrome severity and henceforth for management of implanted generator of electric pulses during conduction of chronic stimulation. Conclusion: The algorithm for determination of optimal parameters for spinal cord electrostimulation in treatment of chronic pain syndrome standardizes the procedure of test process which allows determing the «problem areas» in each clinical case and repeating the operational sequence for choice of optimal stimulation mode if it is necessary. All these mentioned factors reduce the risk of useless (without adequate therapeutic effect) implantation of generator of electric pulses.