Model-based stimulation optimization for chronic pain suppression using percutaneous and surgical leads in spinal cord stimulation (SCS)

The primary indication of SCS is chronic pain, in particular neuropathic pain. It is a highly debilitating condition, and in particular, is estimated to affect about one-fifth of the population in Europe (18% in the Netherlands). SCS, which uses electrical stimulation, is a valuable treatment for chronic intractable intensity and substituting it with a tingling paresthesia sensation . The overall success rate of this treatment modality is about 70%. As a potential improvement, this thesis presents the clinical and technical aspects of stimulation optimization techniques for chronic pain relief in SCS. The optimization techniques are aimed to focus primarily on improving SCS equipment. In particular, the thesis investigates the performance of novel percutaneous and surgical triple-lead configuration designs, with both longitudinal and transverse tripolar contact combinations, in a current-controlled stimulation approach. Effects of percutaneous lead alignment/misalignement, varied transversal lead spacing, preferred choice of leads (surgical/percutaneous), and IPG design are also modelled as ways to potentially improve SCS equipment.