Robert B. Wilson, II, MD, founder and medical director of Piedmont Interventional Pain Care in Salisbury, North Carolina, co-authored two significant studies with sponsored by Boston Scientific. These studies were presented last week at the American Society of Interventional Pain Physicians (ASIPP) in Las Vegas, NV. The two studies included enhanced energy efficiency for spinal cord stimulation outcomes and outcomes using an interspinous spacer for the treatment of lumbar spinal stenosis.
“I was asked to participate in these studies because of my volume of results and the benefits seen in using them. It is important for the science of pain medicine to evaluate procedures that are performed in order to progress in this field,” Dr. Wilson said. “I feel it necessary to share my results and data from these procedures so that they can show proof of being effective. By doing so, insurance carriers can recognize new procedures as beneficial and implement them into their coverage determinations. But, most importantly, it overall benefits my chronic pain patients and provides them with pain-relieving procedures that allow us to avoid or minimize opioid use.”
Enhanced Energy Efficiency and Spinal Cord Stimulation Outcomes using Fast-Acting Sub-Perception Therapy (FAST) for Chronic Pain
Spinal Cord Stimulation (SCS) is traditionally delivered to patients in a continuous manner (i.e., temporally non-varied waveform) for chronic pain. However, it has been well-established that cycling of stimulation, defined as the intermittent activation (ON) and de-activation of stimulation (OFF), can achieve therapeutic benefit for those utilizing SCS to treat chronic pain.¹ As such, cycling of SCS-based neurostimulation may prevent the development of neural tolerance and enable greater control of the dose of electrical energy delivered to neural tissues as well as increase the longevity of implanted devices.² Recently, Fast-Acting Sub-Perception Therapy (FAST), a novel SCS-based approach that can provide pain relief within minutes of initial activation without the need for paresthesia in order to achieve clinically-meaningful analgesia, has been reported.³ (refer to documentation)
The report documented initial, real-world experience utilizing FAST cycling to determine if improved device longevity and efficient usage may be achieved by lowering the charge burden while maintaining pain relief.
The SCS study determined the following conclusions:
Preliminary results from this multi-center, observational case series demonstrate that FAST cycling can enable better management of battery consumption while maintaining substantial pain relief.
Real-World Pain Relief Outcomes Using an Interspinous Spacer for Treatment of Lumbar Spinal Stenosis
Patients with Lumbar Spinal Stenosis (LSS), Indirect Decompression Systems (IDS) or interspinous Spacers (ISS) can be used to achieve long-term clinical benefits with sustained pain relief, improved quality of life, and medication reduction of up to 5-years post-implant.1-3 In addition, in patients implanted with an ISS out to 12- months post-operation, effective leg pain responder rate and pain severity (75% and 60%, respectively) have been demonstrated.4 We sought to examine real-world outcomes derived from a cohort of patients who used an Indirect Decompression System for LSS post-one-year implant as part of a multicenter, observational study. (click here to view the documentation)
Real-world reports demonstrated excellent long-term clinical benefits for patients, including leg pain responder rate and pain severity of 75% and 60%, respectively, at 12 months post-operation. (refer to documentation)
The report documented real-world outcomes in patients with severe pain who received an Indirect Decompression System (IDS) for LSS related pain and symptoms as part of an ongoing multi-center observational case series
The study determined the following conclusions:
Results from this ongoing real-world observational case series of severe pain patients (8 or more on NRS) who received an IDS for the treatment of their LSS.
- Patients reported a mean NRS pain score of 9.4 ± 0.5 prior to IDS implant.
- A 5.4-point improvement was reported at the last follow-up (mean = 115 days).
- Additional data collection and analysis are ongoing and will be presented.
This preliminary evidence aligns with data from previous reports in the peer-reviewed literature.
Dr. Wilson has grown a pain care practice based on interventional treatment options for pain. Piedmont Interventional Pain Care is dedicated to reducing or eliminating the need for pain medications and providing effective procedures that help patients lead a more active and fulfilling lifestyle.
Dr. Wilson is an active advocate for preventing opioid abuse and serves on the opioid task forces for the Department of Health and Human Services, the Industrial Commission of North Carolina, the North Carolina Medical Board, and the North Carolina Medical Society. Additionally, Dr. Wilson is a long-standing member of the Pain Society of the Carolinas, also known as PSOC, and past president of the PSOC. He also has served as chairman of the government advocacy committee. Dr. Wilson is a lecturer for Boston Scientific and is committed to research and education regarding interventional pain management.
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SCS Study – Authors
James North, Richard Ferro, Tim Leier, William Newton, Robert Wilson, Lilly Chen, Roshini Jain
IDS Study – Authors and References
Esposito1, Holly Kaufman, MSc Mrs.2, Richard Ferro, MD Dr.3, John Chatas, MD Dr.4, Michael Verdolin, MD Dr.5, John Hatheway, MD Dr.6, Robert Wilson, MD Dr.7, Jessica Jameson, MD Dr.8, Lilly Chen, MD Dr.9, Roshini Jain, MSc Mrs.9;
1. Nunley et al., Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis. Clin lnterv Aging 2017 Sep 6;12:1409-1417.
2. Nunley PD, Patel VV, Orndorff DG, Lavelle WF, Block JE, Geisler FH. lnterspinousprocess decompression improves quality of life in patients with lumbar spinal stenosis.Minim Invasive Surg. 2018;2018:1035954.
3. Nunley PD, Deer TR, Benyamin RM, Staats PS, Block JE. lnterspinous processdecompression is associated with a reduction in opioid analgesia in patients with lumbarspinal stenosis. J Pain Res. 2018;11:2943-2948.
4. Tekymster et al., lnterspinous Process Decompression With The Superion ® Spacer Forlumbar Spinal Stenosis: Real-World Experience From A Device Registry Med Devices. 2019 3; 12:423-427.
View the original post on the Piedmont Interventional Pain Care website.
