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Rigoard P, Ounajim A, Goudman L, Bouche B, Roulaud M, Page P, Lorgeoux B, Baron S, Nivole K, Many M, Adjali N, Charrier E, Rannou D, Poupin L, Wood C, David R, Héraud D, Moens M, Billot M. The Added Value of Subcutaneous Peripheral Nerve Field Stimulation Combined with SCS, as Salvage Therapy, for Refractory Low Back Pain Component in Persistent Spinal Pain Syndrome Implanted Patients: A Randomized Controlled Study (CUMPNS Study) Based on 3D-Mapping Composite Pain Assessment. J Clin Med 2021; 10:5094. [PMID: 34768614 PMCID: PMC8584602 DOI: 10.3390/jcm10215094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain, when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a "Failed SCS Syndrome" in the back pain component. Fourteen patients were included in this study and randomized into 2 groups ("SCS + PNfS" group/n = 6 vs. "SCS only" group/n = 8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the "SCS + PNfS" group (80.2% ± 21.3%) compared to the "SCS only" group (13.2% ± 94.8%) (p = 0.012), highlighting the clinical interest of SCS + PNfS, in cases where SCS fails to address back pain.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Benedicte Bouche
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Philippe Page
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Nihel Adjali
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Elodie Charrier
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Delphine Rannou
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Laure Poupin
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Chantal Wood
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
| | - Dylan Héraud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Maartens Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
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