Introduction: Spinal cord stimulation (SCS) is an effective treatment for certain chronic pain conditions. Proposed mechanisms of SCS include modulation of the ascending lateral, ascending medial, and descending pain pathways. Conditioned pain modulation (CPM) evaluates the descending pathway by measuring ways a first painful stimulus is affected by a second painful stimulus.
Objectives: We aim to increase insight into SCS mechanisms by exploring cortical activity in response to painful stimuli under various SCS paradigms and assessing how these responses are influenced by CPM.
Materials and methods: 21 patients with persistent spinal pain syndrome type 2 treated with SCS underwent three sessions (under tonic, burst, and sham SCS) with a one-week interval. Using magnetoencephalography, we measured the cortical responses to painful electrical stimuli before, during, and afterCPM. Cortical activity was analyzed in the time domain (evoked response) and time-frequency domain (beta event-related synchronization [ERS]).
Results: Data from 14 patients qualified for analysis. Before CPM, the lowest amplitude of evoked responses occurred under tonic SCS, followed by sham SCS (p > 0.05). The lowest power of beta ERS occurred under sham SCS (p > 0.05). Pain ratings of the stimuli were statistically significantly reduced during CPM (p < 0.05). The amplitude of evoked responses was statistically significantly reduced in multiple regions during CPM under sham and burst SCS (p < 0.05). The power of beta ERS was reduced during CPM under tonic and burst SCS, whereas no reduction was observed under sham SCS (p > 0.05).
Discussion: This exploratory study indicates that evoked and induced cortical responses reflect distinct mechanisms during CPM under SCS. Evoked responses, which primarily reflect bottom-up sensory processing, may be reduced by tonic SCS in the ascending lateral pathway areas before CPM. This reduction may suggest that tonic SCS suppresses input of the ascending lateral pathway, limiting additional inhibition by CPM. Beta ERS (induced response), which primarily reflects top-down modulation, decreased during CPM under tonic and burst SCS, suggesting engagement of the descending pain pathway.
Introduction: As patients seek health information online, platforms such as Reddit may offer insight into common questions and claims regarding deep brain stimulation (DBS). We evaluate Reddit to identify the types of questions users ask and the commentary they share, which may influence ways DBS is understood by patients and caregivers using Reddit as a health information space.
Materials and methods: We performed a qualitative analysis of Reddit posts from targeted subreddit communities. Python Reddit API Wrapper was used for data extraction. Posts were categorized by user perspective (eg, patient, provider, and family/friend) and DBS relationship (eg, after, expecting, and considering). Content was thematically coded into topics and subtopics, classified as either question or commentary, and analyzed for tone.
Results: A total of 2176 posts were included: 556 were questions and 1620 shared experiences or information. Discussions primarily centered on amount of symptom relief (n = 603), surgical preparation and recovery (n = 176), candidacy (n = 183), surgical risks (n = 169), and timing of relief (n = 114). Topic distribution was similar across questions and commentary. Of inquiry posts with an identifiable user perspective (n = 375), most were posted by patients (61.7%), followed by friends/family (37.7%), and most often in a neutral tone (73.0%). Commentary showed more tone variation, with a positive tone toward the amount of symptom relief (65.2%), typically based on personal experience, and negative tone toward surgical risks and adverse events (55.5%), often shared on behalf of family/friends.
Conclusion: Our analysis identified areas in which educational efforts may be directed on social media. In addition, Reddit discussions may overrepresent significant symptom relief or adverse surgical events, potentially shaping skewed perspectives of DBS outcomes. As a source of questions and shared experiences, Reddit offers insight into patient perspectives and serves as a tool to improve patient engagement and education.
Objectives: Spinal cord stimulation (SCS) is an established option for managing neuropathic pain; however, open-loop systems deliver fixed stimulation that may lead to variable efficacy. Closed-loop SCS, which uses evoked compound action potentials (ECAPs) to adjust stimulation in real time, may provide more consistent and superior pain relief. Our objective is to systematically review and meta-analyze the efficacy, safety, and functional outcomes of ECAP-controlled CL-SCS in adults with chronic pain.
Materials and methods: A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Scopus identified randomized controlled trials and observational studies evaluating ECAP-based CL-SCS. The primary outcome was overall pain response (≥50% relief). Secondary outcomes included high pain response (≥80%), functional improvement, quality-of-life (QoL) enhancement, opioid reduction, sleep improvement, patient satisfaction, and adverse events. Pooled prevalence was calculated using random-effects single-arm meta-analysis.
Results: Seven studies (453 patients) were included, with follow-up ranging from 4.5 days to 36 months. Pooled rates were overall pain response 90% (95% CI: 79.0-97.0), high pain response 57% (41.0-72.0), functional improvement 90% (74.0-99.0), QoL improvement 84% (75.0-92.0), opioid reduction or elimination 77% (49.0-97.0), sleep improvement 66% (54.0-77.0), and patient satisfaction 98% (91.0-100.0). Serious adverse events were rare, and most complications were mild and device related. Heterogeneity was high for most outcomes, except QoL and opioid reduction or elimination.
Conclusions: ECAP-controlled CL-SCS provides high and consistent rates of pain relief, functional and QoL improvements, and patient satisfaction, with an acceptable safety profile. Benefits include reduced use of opioids and improved sleep. Larger, long-term, and health economics studies are needed to optimize programming parameters and guide broader implementation.
Objectives: This network meta-analysis (NMA) aimed to evaluate the comparative efficacy of different functional magnetic stimulation (FMS) protocols-including stimulation site, frequency, and duration-on urodynamic and symptom outcomes in patients with neurogenic detrusor overactivity (NDO), and to provide evidence-based guidance on treatment parameters.
Materials and methods: A systematic search was conducted across PubMed, Embase, Medline, Web of Science, Scopus, Ovid, CNKI, Chinese Biomedical Database, Wanfang, Weipu, and ClinicalTrials.gov up to October 20, 2023. Randomized controlled trials (RCTs) involving patients with NDO secondary to neurologic disorders and reporting urodynamic or symptom outcomes (including maximum cystometric capacity [MCC], daily urinary incontinence [UI] episodes, Pvesmax, volume at first desire to void [FDV], postvoid residual urine volume [PVR], average voided volume [AVV], etc) were included. Interventions included any FMS protocol, including repetitive transcranial magnetic stimulation (TMS), repetitive transpinal magnetic stimulation (rTSMS), and repetitive sacral magnetic stimulation (SMS). Safety outcomes, including adverse events, also were considered.
Results: The study included 20 RCTs involving 1316 participants, and all trials were used for the meta-analysis. SMS significantly improved MCC (MD: 31.94 mL; 95% CI, 8.18-55.71), and reduced PVR (MD: 24.33 mL; 95% CI, -42.89 to -5.77) vs control. TMS decreased FDV (MD: -59.70 mL; 95% CI, -96.45 to -22.95). Among the frequencies evaluated, 15 Hz produced the largest improvement in MCC (+39.41 mL; 95% CI, 15.09-63.74), ranking highest among tested frequencies. An eight-week regimen achieved the greatest MCC improvement (+46.16 mL; 95% CI, 11.79-80.51) and ranked highest by p-score among the treatment durations evaluated. SMS was superior for reducing daily UI episodes (Surface Under the Cumulative Ranking curve: 0.86).
Conclusions: FMS, particularly SMS, significantly improves bladder storage capacity and reduces incontinence in patients with NDO. Among evaluated parameters, 15-Hz stimulation and an eight-week regimen were associated with the greatest improvements in MCC; however, these parameters were analyzed independently, and evidence regarding their combined effects or interactions across stimulation sites is limited. TMS showed mixed effects, increasing AVV but decreasing FDV, suggesting enhanced bladder sensitivity rather than improved storage. These findings indicate that SMS has the most favorable profile among single-parameter comparisons, but further studies are needed to evaluate combinations of stimulation site, frequency, and duration, in addition to individualized treatment strategies for NDO.
Background: Deep brain stimulation (DBS) has been proposed as a promising therapeutic intervention for patients with disorders of consciousness (DoC). DBS is hypothesized to modulate brain activity in local and widespread functional networks by delivering electrical impulses to deep brain nuclei, thereby promoting arousal.
Objectives: This individual patient data meta-analysis aimed to evaluate the therapeutic impact of DBS on improving conscious awareness in patients with DoC and to identify potential predictors of treatment responsiveness.
Materials and methods: Nine studies comprising 81 patients with DoC who underwent DBS were included. The primary outcome measure across all studies was the Coma Recovery Scale-Revised (CRS-R). Subgroup analyses were performed based on age, duration of DoC, etiology, and DBS target. Study-level data were pooled using random-effects meta-analytic models.
Results: The pooled mean CRS-R improvement post-DBS was 2.15 (95% CI: 1.06-3.23), indicating a modest treatment effect. Only 39.5% of patients achieved the minimum clinically important difference of ≥three CRS-R points, and 30.9% transitioned to a higher DoC category. Younger patients with shorter DoC durations tended to show greater improvements. Etiology was largely nonpredictive, although patients with hypoxic-ischemic encephalopathy exhibited marginally better responses. Considerable heterogeneity was observed across studies (I2 = 76.5%). Adverse effects, including infections and seizures, were reported.
Conclusions: DBS may confer modest improvements in conscious awareness for selected patients with DoC, but therapeutic benefits remain limited and risks substantial. Rigorous patient selection frameworks and standardized protocols are essential to guide clinical decision-making and future trials.
Background: Chronic pain is a common and debilitating consequence of stroke. Although pharmacologic interventions are typically the first-line treatment, they often have limited efficacy and carry risks such as side effects and dependence. Evidence for neuromodulation therapies is positive but limited owing to high cost and invasiveness. Therefore, developing noninvasive, affordable neuromodulation approaches for treating poststroke pain could offer significant clinical benefits. Transcutaneous auricular neurostimulation (tAN), an affordable and wearable neuromodulation technique, has shown promise for analgesia, but research specific to poststroke pain remains limited.
Objectives: This pilot study aims to explore the safety/feasibility, in addition to the analgesic effects, of tAN in patients with stroke with chronic upper-extremity pain.
Materials and methods: Overall, 15 patients with stroke with chronic upper-extremity pain were enrolled. Each participant received a single 30-minute session of tAN (active or sham). Subjective stroke-related pain ratings and thermal pain thresholds (through quantitative sensory testing; QST) were collected immediately before and after the 30-minute tAN session. Repeated-measures two-way analyses of variance were performed with group (sham vs active tAN) and time (pre- vs post-tAN) as factors to evaluate the potential analgesic effects of tAN on both pain measures.
Results: QST pain threshold analysis in the 14 patients who completed the study revealed a significant time × group interaction [F(1,12) = 7.658, p = 0.017]. Post hoc analysis indicated a potentiation in pain threshold after active stimulation (p = 0.032), whereas no change was observed in the sham group.
Conclusions: This pilot study showed that tAN is safe and feasible for patients with chronic poststroke pain. Although subjective pain scores improved in both groups, pain threshold increased significantly in the active group compared with the sham. Future studies should aim to assess long-term efficacy and optimized parameters, dosing, and treatment duration of tAN for this clinical population to aid in poststroke pain.
Clinical trial registration: The Clinicaltrials.gov registration number for the study is NCT06456385.
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