Postural Changes in Spinal Cord Stimulation Thresholds: Current and Voltage Sources

Richard B North; Jung H Sung; Liam A Matthews; Hans J Zander; Scott F Lempka

doi:10.1016/j.neurom.2023.08.006

Postural Changes in Spinal Cord Stimulation Thresholds: Current and Voltage Sources

Neuromodulation. 2024 Jan;27(1):178-182. doi: 10.1016/j.neurom.2023.08.006. Epub 2023 Oct 7.

Authors

Richard B North¹, Jung H Sung², Liam A Matthews³, Hans J Zander³, Scott F Lempka⁴

Affiliations

¹ Neuromodulation Foundation, Inc, Baltimore, MD; Departments of Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: DrRNorth@hotmail.com.
² Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI; Biointerfaces Institute, University of Michigan, Ann Arbor, MI.
⁴ Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI; Biointerfaces Institute, University of Michigan, Ann Arbor, MI; Department of Anesthesiology, University of Michigan, Ann Arbor, MI.

PMID: 37804279
DOI: 10.1016/j.neurom.2023.08.006

Abstract

Objective: Spinal cord stimulation (SCS) thresholds are known to change with body position; however, these changes have not been fully characterized for both "constant-voltage" and "constant-current" pulse generators. This study aimed to evaluate and quantify changes in psychophysical thresholds resulting from postural changes that may affect both conventional paresthesia-based SCS and novel paresthesia-free SCS technologies.

Materials and methods: We measured perceptual, usage, and discomfort thresholds in four body positions (prone, supine, sitting, standing) in 149 consecutive patients, with temporary lower thoracic percutaneous epidural electrodes placed for treating persistent low back and leg pain. We trialed 119 patients with constant-voltage stimulators and 30 patients with constant-current stimulators.

Results: Moving from supine to the sitting, standing, or prone positions caused all three thresholds (perceptual, usage, and discomfort) to increase by 22% to 34% for constant-voltage stimulators and by 44% to 82% for constant-current stimulators. Changing from a seated to a supine position caused stimulation to exceed discomfort threshold significantly more often for constant-current (87%) than for constant-voltage (63%) stimulators (p = 0.01).

Conclusions: Posture-induced changes in SCS thresholds occurred consistently as patients moved from lying (supine or prone) to upright (standing or sitting) positions. These changes were more pronounced for constant-current than for constant-voltage pulse generators and more often led to stimulation-evoked discomfort. These observations are consistent with postural changes in spinal cord position measured in imaging studies, and with computer model predictions of neural recruitment for these different spinal cord positions. These observations have implications for the design, implantation, and clinical application of spinal cord stimulators, not only for conventional paresthesia-based SCS but also for paresthesia-free SCS.

Keywords: Chronic pain; electric stimulation; neuromodulation; neuropathic pain; spinal cord stimulation.

MeSH terms

Humans
Pain / complications
Pain Management / adverse effects
Paresthesia / etiology
Paresthesia / therapy
Posture
Spinal Cord / diagnostic imaging
Spinal Cord Stimulation* / methods