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40 Executive Briefing Treating Chronic Pain with 3D Neural Targeting and Waveform Variation F or more than 100 million Americans with chronic pain, find- ing an effective treatment can involve trying several differ- ent treatment options with each having very different clin- ical outcomes. 1 At a recent roundtable discussion at the 2017 North American Neuromodulation Society Annual Meeting, leading experts in the field of pain management discussed how to improve the care continuum for patients with chronic pain and shared insights on recent research in spinal cord stimula- tion (SCS). With long-term opioid prescriptions for chronic pain contribut- ing to the nation's opioid crisis, physicians are now evaluating how to treat chronic pain with options that reduce the over-reli- ance on opioids. One treatment option that many are revisiting is SCS which, since its introduction more than 40 years ago, has made great advancements in its ability to target pain and pro- vide patients with long-term relief. "When people think about pain management, it's often synon- ymous with opioids," said Julie Pilitsis, M.D., Ph.D., professor, neurosurgery and neuroscience and chair of the Department of Neuroscience and Experimental Therapeutics, Albany Medical College. "We have to expand our treatment options and medi- cal treatments to include interactive therapies and SCS." In the discussion, which was moderated by Richard Rauck, M.D., founder, Carolinas Pain Institute, the panelists noted that there are a number of common conditions which indicate that a pa- tient could be a candidate for SCS including failed back surgery syndrome and neuropathic pain. Patients with these conditions are frequently being treated with SCS. "It's critical to understand the root cause of a patient's pain whenever possible. For a sizeable group of patients, SCS should be used earlier in the treatment algorithm, especially as the technology continues to advance to reach a broader range of patients with chronic pain," said Dr. Rauck. James North, M.D., pain specialist, Carolinas Pain Institute and assistant professor, Wake Forest University Baptist Medical Cen- ter added, "There is a vacuum of treatment options for neuro- pathic pain. Based on my clinical experience, SCS is an effective modality in treating the most refractory type of pain and that's neuropathic pain." The evolution of spinal cord stimulation The most advanced SCS systems are designed to address many of the challenges of earlier models where patients would expe- rience stimulation of adjacent non-targeted nerves or possibly become non-responsive to the treatment over time. Recent technology uses 3D neural targeting which is engineered to enable physicians to precisely target the area in the dorsal col- umn that is intended to best treat the patient's pain. Additionally, these systems can more readily respond to pain as it changes over time by delivering waveforms of different shapes, intensity, frequency and duration. "What I've noted in my practice with spinal cord stimulation is the technique and the quality of the technology has advanced to the point that we're having unprecedented success. It's not uncom- mon for us to see 100 percent pain relief using this modality," shared Stephen Pyles, M.D., founder, Pain Treatment Centers. The Boston Scientific portfolio of SCS Systems with the Illumina 3D™ Programming Algorithm incorporates these latest innova- tions. Its technology is based on a 3D anatomical model of the spinal cord that takes into account the electrical conductivity of spinal column structures, relative lead location and vertebral level of the leads. Using these inputs, the algorithm is intended to cal- culate the optimal fractionalized program configuration to target the selected central point of stimulation. Once the recommend- ed neural target is identified, MultiWave™ Technology allows pain therapy to be further customized for each individual patient through the delivery of a variety of waveforms and field shapes. In a recent device registry evaluation of data using the Boston Scientific Precision Spectra™ System, 60 percent of patients used one or more advanced waveforms to treat their pain. "Given the complex nature of chronic pain, it stands to reason that one type of stimulation is unlikely to be the answer to all pain phenotypes," said Dr. Julie Pilitsis. Research highlights A 24-month analysis that compared the effectiveness of 3D neural targeting used in the Boston Scientific Precision Spectra™ System with an earlier generation SCS system also from Boston Scientific offers new insight on treating low back pain. Thirty to forty per- cent of the patients in the LUMINA Study had low back pain only, making the LUMINA Study one of the largest observational cohort (213 subjects) studies in SCS of patients with this type of pain. The roundtable participants noted that new research offers hope for these patients and the potential to address the impact chronic pain has on their life. Low back pain is a prevalent condition which costs the United States more than $100 billion annually with two- thirds of that due to lost wages and decreased productivity. 2,3 Prism TM 3D Targeting Technology Burst 3D Stimulation HR 3D Stimulation Advanced SCS waveforms and field shapes Sponsored by: