Spinal cord stimulation and modulation of neuropathic pain

This thesis reports on the opportunities of several new applications of spinal cord stimulation (SCS) for the treatment of neuropathic pain. Our pilot study and consecutively performed international randomised controlled trial on effects of SCS in patients with painful diabetic neuropathy showed that SCS offers an effective therapy for chronic pain due to diabetes. We demonstrated that patients, who did not respond to conventional medical treatment, experienced significant reduction in pain intensity when they received SCS. The evaluation of a new SCS electrode lead that is paddle shaped but can be implanted percutaneously, showed that the electrode induces significant pain relief in both low back and lower limbs. These results are comparable or compare favourably to earlier studies with other types of electrode. The evaluation of the recently emerged burst SCS paradigm, that combines features of high frequency stimulation with conventional stimulation demonstrated that about 60% of our patients experienced further pain reduction upon application of burst stimulation. Finally, we showed that living successfully with SCS requires patients to enter an intimate relationship with the device. Insight in the incorporation processes when counselling patients or when designing new technology is essential for further improving SCS therapy.