Radiofrequency spinal cord stimulation shows improved longer-lasting pain relief

Scientists reported high-frequency SCS proved more effective at improving perceived pain reduction (PPR) than low-frequency SCS in patients studied, and there was some variation in PPR between male and female patients.

   

According to a new study, chronic pain spinal cord stimulation (SCS) uses an implanted device to supply a small amount of electricity directly to the spinal cord, altering or blocking nerve activity and minimizing the sensation of pain reaching the brain.

The findings of the research were published in the journal 'Bioelectronic Medicine', a research team led by scientists at the University of California San Diego School of Medicine.

Scientists reported high-frequency SCS proved more effective at improving perceived pain reduction (PPR) than low-frequency SCS in patients studied, and there was some variation in PPR between male and female patients.

Low-frequency SCS (50 Hz) was originally approved by the U.S. Food and Drug Administration (FDA) as a treatment for intractable back and leg pain in 1989. In 2015, the FDA approved high-frequency SCS (10,000 Hz), which delivers electrical stimulation pulses that are shorter in duration, lower in amplitude and do not induce paresthesia, the abnormal sensation of tingling or prickling.

The newly published retrospective study examined 237 patients who had received SCS treatment between 2004 and 2020: 94 patients (40 females, 54 males) who received HF-SCS and 143 patients (70 females and 73 males) who received LF-SCS.

At three and six months post-implantation, the researchers found that PPR across all patients improved compared to baseline, but HF-SCS produced greater PPR than LF-SCS. HF-SCS was also associated with less subsequent use of opioids to mitigate pain.

Male PPR, for example, was significantly better for HF-SCS at three and six months when compared to LF-SCS, while this was only true for females at the 6 month time point.

LF-SCS males used more opioids post-implantation and at six months while females used more opioids post-implantation, at three, six and tended to use more opiates at the 12-month time-point.

"Our work was sparked by a growing literature that demonstrate sex specific immune pathways differentially contribute to chronic pain processes," said senior author Imanuel Lerman, MD, an associate professor of anesthesiology, pain management specialist at UC San Diego Health, and an affiliate of the Qualcomm Institute.

"The observed parameter-specific (high versus low frequency) sex-based differences in spinal cord stimulation efficacy and opiate use are definitely intriguing."

"It's a first step in the right direction, but clearly more work needs to be done to carefully characterize sex specific pain regulatory pathways that may prove responsive to specific types of neuromodulation and or pharmaceutical therapies."

 

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Improved MRI scans could aid in development of arthritis treatments

An algorithm that analyses MRI images and automatically detects small changes in knee joints over time could be used in the development of new treatments for arthritis.

 A team of engineers, radiologists and physicians, led by the University of Cambridge, developed the algorithm, which builds a three-dimensional model of an individual's knee joint in order to map where arthritis is affecting the knee. It then automatically creates 'change maps' which not only tell researchers whether there have been significant changes during the study but allow them to locate exactly where these are.

There are few effective treatments for arthritis, and the technique could be a considerable boost to efforts to develop and monitor new therapies for the condition. The results are reported in the Journal of Magnetic Resonance Imaging. 

Osteoarthritis is the most common form of arthritis in the UK. It develops when the articular cartilage that coats the ends of bones and allows them to glide smoothly over each other at joints, is worn down, resulting in painful, immobile joints. Currently there is no recognised cure and the only definitive treatment is surgery for artificial joint replacement.

Osteoarthritis is normally identified on an X-ray by a narrowing of the space between the bones of the joint due to a loss of cartilage. However, X-rays do not have enough sensitivity to detect subtle changes in the joint over time.

 "We don't have a good way of detecting these tiny changes in the joint over time in order to see if treatments are having any effect," said Dr James MacKay from Cambridge's Department of Radiology, and the study's lead author. "In addition, if we're able to detect the early signs of cartilage breakdown in joints, it will help us understand the disease better, which could lead to new treatments for this painful condition."

The current study builds on earlier work from the same team, who developed an algorithm to monitor subtle changes in arthritic joints in CT scans. Now, they are using similar techniques for MRI, which provides more complete information about the composition of tissue - not just information about the thickness of cartilage or bone. 

MRI is already widely used to diagnose joint problems, including 

arthritis, but manually labelling each image is time-consuming, 

and may be less accurate than automated or semi-automated 

techniques when detecting small changes over a period of months 

or years.

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