Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives
<b>Background:</b> Chronic pain remains a major clinical challenge, which is often resistant to conventional treatments. Spinal cord stimulation has been used for decades to manage refractory pain, traditionally relying on open-loop systems with fixed-output stimulation. However, these s...
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2025-04-01
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| author | Nicholas Mangano Andrew Torpey Catherine Devitt George A. Wen Christopher Doh Abhishek Gupta |
| author_facet | Nicholas Mangano Andrew Torpey Catherine Devitt George A. Wen Christopher Doh Abhishek Gupta |
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| description | <b>Background:</b> Chronic pain remains a major clinical challenge, which is often resistant to conventional treatments. Spinal cord stimulation has been used for decades to manage refractory pain, traditionally relying on open-loop systems with fixed-output stimulation. However, these systems fail to account for physiological variability, leading to inconsistent pain relief. Closed-loop spinal cord stimulation represents a significant advancement by utilizing evoked compound action potentials to continuously modulate stimulation intensity in real-time, ensuring more stable and effective pain management. <b>Methods</b>: A comprehensive literature review was conducted using PubMed and ClinicalTrials.gov to identify and synthesize relevant published and ongoing studies with a focus on open-loop spinal cord stimulation for managing lower back pain. <b>Results</b>: Clinical trials, including the Avalon and Evoke studies, have demonstrated that closed-loop spinal cord stimulation provides superior pain relief, functional improvement, and reduced opioid dependence compared to traditional open-loop systems. Patients receiving closed-loop stimulation reported significantly higher rates of sustained pain reduction, improved quality of life, and fewer complications related to overstimulation. Emerging studies suggest its potential for conditions beyond back pain, such as neuropathic pain, cancer-related pain, and Raynaud’s phenomenon. Furthermore, cost-effectiveness analyses indicate that closed-loop spinal cord stimulation is a more economically viable treatment option compared to conventional medical management and open-loop systems. <b>Conclusions</b>: Closed-loop spinal cord stimulation represents a transformative development in neuromodulation, offering personalized and adaptive pain management that is distinct from open-loop spinal cord stimulation. Further research is warranted to explore its long-term durability, broader applications, and integration with emerging technologies in pain management. |
| format | Article |
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| institution | Kabale University |
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| spelling | doaj-art-f9e7f52f271c46f3ad4a93b6de5cd29f2025-08-20T03:47:50ZengMDPI AGBiomedicines2227-90592025-04-01135109110.3390/biomedicines13051091Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging PerspectivesNicholas Mangano0Andrew Torpey1Catherine Devitt2George A. Wen3Christopher Doh4Abhishek Gupta5Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, New York, NY 11794, USADepartment of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, New York, NY 11794, USADepartment of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, New York, NY 11794, USARenaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, New York, NY 11794, USADepartment of Anesthesiology, Division of Chronic Pain, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, New York, NY 11794, USADepartment of Anesthesiology, Division of Chronic Pain, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, New York, NY 11794, USA<b>Background:</b> Chronic pain remains a major clinical challenge, which is often resistant to conventional treatments. Spinal cord stimulation has been used for decades to manage refractory pain, traditionally relying on open-loop systems with fixed-output stimulation. However, these systems fail to account for physiological variability, leading to inconsistent pain relief. Closed-loop spinal cord stimulation represents a significant advancement by utilizing evoked compound action potentials to continuously modulate stimulation intensity in real-time, ensuring more stable and effective pain management. <b>Methods</b>: A comprehensive literature review was conducted using PubMed and ClinicalTrials.gov to identify and synthesize relevant published and ongoing studies with a focus on open-loop spinal cord stimulation for managing lower back pain. <b>Results</b>: Clinical trials, including the Avalon and Evoke studies, have demonstrated that closed-loop spinal cord stimulation provides superior pain relief, functional improvement, and reduced opioid dependence compared to traditional open-loop systems. Patients receiving closed-loop stimulation reported significantly higher rates of sustained pain reduction, improved quality of life, and fewer complications related to overstimulation. Emerging studies suggest its potential for conditions beyond back pain, such as neuropathic pain, cancer-related pain, and Raynaud’s phenomenon. Furthermore, cost-effectiveness analyses indicate that closed-loop spinal cord stimulation is a more economically viable treatment option compared to conventional medical management and open-loop systems. <b>Conclusions</b>: Closed-loop spinal cord stimulation represents a transformative development in neuromodulation, offering personalized and adaptive pain management that is distinct from open-loop spinal cord stimulation. Further research is warranted to explore its long-term durability, broader applications, and integration with emerging technologies in pain management.https://www.mdpi.com/2227-9059/13/5/1091closed-loop spinal cord stimulationspinal cord stimulationchronic painlower back painneuromodulationevoked compound action potentials |
| spellingShingle | Nicholas Mangano Andrew Torpey Catherine Devitt George A. Wen Christopher Doh Abhishek Gupta Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives Biomedicines closed-loop spinal cord stimulation spinal cord stimulation chronic pain lower back pain neuromodulation evoked compound action potentials |
| title | Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives |
| title_full | Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives |
| title_fullStr | Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives |
| title_full_unstemmed | Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives |
| title_short | Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives |
| title_sort | closed loop spinal cord stimulation in chronic pain management mechanisms clinical evidence and emerging perspectives |
| topic | closed-loop spinal cord stimulation spinal cord stimulation chronic pain lower back pain neuromodulation evoked compound action potentials |
| url | https://www.mdpi.com/2227-9059/13/5/1091 |
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