New technique stimulates relief for chronic pain sufferers

A 12-month trial of two different spinal cord stimulation (SCS) techniques has found that a new SCS algorithm — DTM SCS — outperformed conventional SCS treatment in reducing pain scores in patients with chronic, intractable pain.

Delivered as a programming option via the Medtronic Intellis SCS platform, the DTM waveform may engage a novel mechanism that modulates neurons and glial cells. Glial cells outnumber neurons in the spinal cord by 12:1 and their role in pain has been explored in research for more than 20 years.^1–3

Medtronic recently announced statistically significant results from the multicentre randomised controlled trial that demonstrated the importance of DTM SCS in providing back pain relief compared with conventional SCS therapy.

“DTM SCS is based on a novel understanding of how neurons and glial cells contribute to chronic pain,” explained Charlie Covert, Vice President and General Manager of the Pain Therapies business at Medtronic.

“The 12-month data reported demonstrate the value of Medtronic’s continued focus on pursuing science-based approaches to improving human health and underscore our ability to integrate existing technologies with novel therapies like DTM SCS to improve the outcomes of people suffering from chronic pain.”

At 12 months, 84% of patients with chronic back pain treated with DTM SCS reported at least 50% pain relief compared with 51% of patients treated with conventional SCS (p=0.0005).⁴

Figure demonstrating the back pain responder rate at three and 12 months.

Pain relief was measured by the Visual Analogue Scale (VAS), a widely used and accepted measure for pain intensity that records patient-reported pain levels on a scale of 0–10. As measured by VAS, 50% pain relief is a recognised industry standard to define therapy success.⁴ The majority of patients randomised to DTM SCS therapy exceeded this threshold, with seven out of 10 experiencing profound back pain relief at 12 months.

There was also a difference in the proportion of patients who reported profound back pain relief (>80% reduction in VAS score) favouring DTM SCS (69%) compared with conventional SCS (35.1%).⁴

Patients treated with DTM SCS also reported an average VAS score reduction of 75% in back pain, compared with 50% treated with conventional SCS.

Dr Richard Sullivan from Precision Brain, Spine and Pain, who is also Director at Large for the International Neuromodulation Society, was among the first Australian physicians to gain experience with this programming paradigm.

“The 12-month data from Medtronic’s DTM SCS study puts this therapy ahead of other treatments in managing post-surgery back pain,” he said.

“As such, spinal cord stimulation should now become the standard therapy in this condition once spinal stability is confirmed. My personal experience in using DTM SCS therapy for patients in this situation is consistent with these outstanding study results.”

References

1. Milligan ED, Watkins LR. Pathological and protective roles of glia in chronic pain. Nat Rev Neurosci. 2009 Jan;10(1):23-36.
2. Vallejo R, Tilley DM, Vogel L, Benyamin R. The role of glia and the immune system in the development and maintenance of neuropathic pain. Pain Pract. 2010 May-Jun;10(3):167-84.
3. De Leo JA, Tawfik VL, LaCroix-Fralish ML. The tetrapartite synapse: Path to CNS centralization and chronic pain. Pain. 2006; 122:17-21.
4. Fishman M, Cordner H, et al. DTM™ SCS RCT 12-month Data Results. Presented at a Medtronic webinar, jointly supported by the North American Neuromodulation Society (NANS), World Institute of Pain (WIP), and the American Society for Pain and Neuroscience (ASPN). October 19, 2020. Webinar available on society websites.

Top image credit: ©stock.adobe.com/au/Anatomy Insider