Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Parameter Adjustment

What adjustment options are available and when and where should adjustment of stimulation parameters take place?

Parameter adjustment requires the assistance of a trained professional and might require specialized equipment.  Adjustment takes place during the screening-trial period and after SCS implantation.  The goal is to find settings for patients to use as they pursue activities of daily life.  The technical goal is to maximize coverage of pain areas with comfortable or tolerable stimulation paresthesia.  Minimizing power requirements is an additional goal, to the extent that battery life is important.

The number of possible bipolar contact combinations ranges from 50 on an electrode with four contacts to 6050 on an electrode with eight contacts.  The number of possible combinations soars to the millions for electrodes with 16 contacts, which exceeds the number of combinations that can be tested in a timely fashion, even with the aid of computerized adjustment.

The results of computer modeling studies and clinical studies guide the contact configuration strategy, which aims to maximize pain/paresthesia overlap, the range of clinically useful stimulation, and battery life

Strength of recommendation Evidence source(s)/rationale
A = Recommended or required
Valid, useful, or non-negotiable
  • Computer modeling studies
  • Well-designed clinical studies

North RB, Sieracki JN, Fowler KR, Alvarez B, Cutchis PN. Patient-interactive, microprocessor-controlled neurological stimulation system. Neuromodulation 1(4):185-193, 1998.
Abstract | Wikistim Entry

North RB, Fowler K, Nigrin DJ, Szymanski R. Patient-interactive, computer-controlled neurological stimulation system: clinical efficacy in spinal cord stimulator adjustment. J Neurosurg 76(6):967-972, 1992.
Abstract | Wikistim Entry

North RB, Nigrin DA, Fowler KR, Szymanski RE, Piantadosi S. Automated 'pain drawing' analysis by computer-controlled, patient-interactive neurological stimulation system. Pain 50:51-57, 1992.
Abstract | Wikistim Entry

North RB, Ewend ME, Lawton MA, Piantadosi S. Spinal cord stimulation for chronic, intractable pain: superiority of "multi-channel" devices. Pain 44(2):119-130, 1991.
Abstract | Wikistim Entry

North RB, Kidd DH, Olin J, Sieracki JM, Farrokhi F, Petrucci L, Cutchis PN. Spinal cord stimulation for axial low back pain: a prospective, controlled trial comparing dual with single percutaneous electrodes. Spine 30(12):1412-1418, 2005.
Abstract | Wikistim Entry

North RB, Brigham DD, Khalessi A, Calkins S, Piantadosi S, Campbell DS, Daly MJ, Dey B, Barolat G, Taylor R. Spinal cord stimulator adjustment to maximize implanted battery longevity: a randomized, controlled trial using a computerized, patient-interactive programmer. Neuromodulation 7(1):13-25, 2004.
Abstract | Wikistim Entry

North RB, Calkins SK, Campbell DS, Sieracki JM, Piantadosi S, Daly M J, Dey PB, Barolat G. Automated, patient-interactive spinal cord stimulator adjustment: a randomized, controlled trial. Neurosurgery 52(3):572-57-9, 2003.
Abstract | Wikistim Entry

Leclercq TA Electrode migration in epidural stimulation: comparison between single electrode and four electrode programmable leads. Pain 20(Suppl 2):78 1984.
| Wikistim Entry

Law JD. Spinal stimulation: statistical superiority of monophasic stimulation of narrowly separated, longitudinal bipoles having rostral cathodes. Appl Neurophysiol 46(1-4):129-137, 1983.
Abstract | Wikistim Entry

Khalessi AA, Taylor RS, Brigham D, North RB Automated vs. manual spinal cord stimulator adjustment: A sensitivity analysis of lifetime cost data from a randomized controlled trial. Neuromodulation 11(3):182-186, 2008.
Abstract | Wikistim Entry

Bennett DS, Aló KM, Oakley J, Feler CA. Spinal cord stimulation for complex regional pain syndrome I (RSD). A retrospective multicenter experience from 1995-1998 of 101 patients. Neuromodulation 2(3):202-210, 1999.
Abstract | Wikistim Entry

Aló KM, Yland MJ, Kramer DL, Charnov JH, Redko V. Computer assisted and patient interactive programming of dual octrode spinal cord stimulation in the treatment of chronic pain. Neuromodulation 1(1):30-45, 1998.
Abstract | Wikistim Entry

Aló KM, Redko V, Charnov J. Four year follow-up of dual electrode spinal cord stimulation for chronic pain. Neuromodulation 5(2):79-99, 2002.
Abstract | Wikistim Entry