Patient‐Specific Analysis of Neural Activation During Spinal Cord Stimulation for Pain
Objective Despite the widespread use of spinal cord stimulation (SCS) for chronic pain management, its neuromodulatory effects remain poorly understood. Computational models provide a valuable tool to study SCS and its effects on axonal pathways within the spinal cord. However, these models must inc...
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Published in | Neuromodulation (Malden, Mass.) Vol. 23; no. 5; pp. 572 - 581 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.07.2020
Elsevier Limited |
Subjects | |
Online Access | Get full text |
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Summary: | Objective
Despite the widespread use of spinal cord stimulation (SCS) for chronic pain management, its neuromodulatory effects remain poorly understood. Computational models provide a valuable tool to study SCS and its effects on axonal pathways within the spinal cord. However, these models must include sufficient detail to correlate model predictions with clinical effects, including patient‐specific data. Therefore, the goal of this study was to investigate axonal activation at clinically relevant SCS parameters using a computer model that incorporated patient‐specific anatomy and electrode locations.
Methods
We developed a patient‐specific computer model for a patient undergoing SCS to treat chronic pain. This computer model consisted of two main components: 1) finite element model of the extracellular voltages generated by SCS and 2) multicompartment cable models of axons in the spinal cord. To determine the potential significance of a patient‐specific approach, we also performed simulations with standard canonical models of SCS. We used the computer models to estimate axonal activation at clinically measured sensory, comfort, and discomfort thresholds.
Results
The patient‐specific and canonical models predicted significantly different axonal activation. Relative to the canonical models, the patient‐specific model predicted sensory threshold estimates that were more consistent with the corresponding clinical measurements. These results suggest that it is important to account for sources of interpatient variability (e.g., anatomy, electrode locations) in model‐based analysis of SCS.
Conclusions
This study demonstrates the potential for patient‐specific computer models to quantitatively describe the axonal response to SCS and to address scientific questions related to clinical SCS. |
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Bibliography: | For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to www.wiley.com/WileyCDA/Section/id-301854.html ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1094-7159 1525-1403 |
DOI: | 10.1111/ner.13037 |