====== Refractory Neuropathic Pain ======

Chronic [[neuropathic pain]] has been recognized as contributing to a significant proportion of [[chronic pain]] globally. Among these, [[spinal pain]] is of significance with [[failed back surgery syndrome]] (FBSS), generating considerable expense for the health care systems with increasing prevalence and health impact.

===== Treatment =====


see [[Chronic neuropathic pain treatment]].

===== Case series =====


Thirty-four patients with refractory [[chronic neuropathic pain]] were treated with [[spinal cord stimulation]] systems providing [[multiwave]] therapy between September 2018 and October 2019. Patients with a follow-up of at least 6 months were selected; 10 subjects were excluded due to revision surgery, infection, and loss to follow-up. Data regarding pain intensity and preferred waveform for the trial, the implantation, 3-month and 6-month follow-up were recorded.

During the trial phase, 10 patients (43.5%) achieved significant pain relief using [[tonic stimulation]], 5 using [[burst stimulation]] (21.7%), 3 using microburst (13.0%), and 4 using a combination of tonic and microburst (17.4%). One single patient preferred Contour stimulation during the trial. After 3 months, 6 patients preferred microburst (25%), 6 preferred tonic (25%), 5 used a combination of tonic and microburst (20.8%), and 5 patients used burst (20.8%). After 6 months, similar results were obtained. Contour and Whisper were used in complex cases failing to other waveforms.

Tonic stimulation, isolated or in combination, remains an important component in [[spinal cord stimulation]], being used by almost half of the patients. Over time, the usage of microburst increased considerably. Whisper and Contour, although battery-consuming, are good salvage options in complex cases
((S PG, S G, J SP, J V. Combination of waveforms in modern spinal cord stimulation. Acta Neurochir (Wien). 2022 Jan 5. doi: 10.1007/s00701-021-05107-4. Epub ahead of print. PMID: 34988708.)).