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22nd Annual Pain Medicine Meeting 2023

November 10 - 11, 2023 | New Orleans Marriott | New Orleans, Louisiana, USA

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12-MONTH OUTCOMES FROM A MULTI-CENTER STUDY ON A REDUCED-ENERGY DTM™ DERIVATIVE: PATIENT ACTIVITY GOALS AND THERAPY SATISFACTION

Poster Presenter

Maddie LaRue

Authors

Maddie LaRue

Affiliations

Medtronic

Part of Topic

Chronic Pain

12-Month Outcomes from a Multi-Center Study on a Reduced-Energy DTM™ Derivative: Patient Activity Goals and Therapy Satisfaction

Introduction

•Differential Target Multiplexed™ spinal cord stimulation (also known as DTM™ SCS) is an established therapy, shown to provide superior back pain relief to traditional SCS1.
•Derivatives of the DTM™ waveform are being investigated to understand opportunities for therapy personalization including energy-conserving approaches that alter amplitude, frequency, and pulse width.
•This prospective, multi-center, open-label, post-market study evaluated the efficacy of a reduced-energy derivative of DTM™ SCS (DTM™ endurance therapy).
 

Materials & Methods

•SCS candidates with an overall Visual Analog Scale (VAS) of ≥6.0cm with moderate to severe chronic, intractable back and/or leg pain were eligible.
•Eligible subjects underwent an SCS trial programmed with DTM™ endurance therapy and proceeded in the study if successful.
•Evaluation visits occurred at 1-, 3-, 6-, and 12-months post-activation. At evaluation visits, pain relief and quality of life improvements were assessed. Additionally, subjects were asked to set specific, measurable, and realistic goals related to an activity they hoped to achieve throughout the study.
•Activity goals were collected at baseline, 1-, 3-, and 12-month visits. If baseline goal was achieved, then the subject was asked to set a new goal and so on through the 12-month final study visit.
•Achievement status of the 12-month final goal is not known.
•The maximum number of goals a subject could place is 1 per visit, for a total of maximum 4 goals throughout the study.

Results

Demographics

57 subjects enrolled at 12 US sites from November 2020 to June 2021. Patient demographics are shown in Table 1. Post-laminectomy pain/PSPS-T2 was the main etiology (91.2%). 49 subjects underwent trial, 35 were implanted, and 27 completed the 12-Month visit.

Overall, Back, and Leg Pain Scores

The primary objective analysis demonstrated a mean reduction (standard deviation) of 3.9cm (2.5) in overall pain, as measured by Visual Analog Scale (VAS), from baseline at the 3-month follow-up (Figure 1). Changes in overall pain were clinically sustained at 3- , 6-, and 12-months with 50.4%, 52.4%, 56.1% improvement, respectively (Figure 1).

Activity Goals

88.9% of subjects met one or more of their specified activity goals set at baseline by the 12-month visit (Figure 3, Table 2). Activity goals set at baseline fell into 4 of the 5 categories set for analysis (Table 2). Most subjects set baseline goals in the basic movement and sports/higher activity categories (Figure 3). We observed that 94% of responder subjects (≥50% pain relief) at 12-months achieved a goal set at baseline. Interestingly, we observed that 82% of non-responder subjects (did not achieve ≥50% pain relief) at 12-months were still able to achieve a goal set at baseline.

Conclusions

•In addition to assessing pain relief as the traditional core measure of SCS therapy success, this study utilized subject activity goals and therapy satisfaction as measurements of success.
•Although a set of subjects did not achieve the conventional benchmark of ≥50% pain relief, an overwhelming majority of subjects successfully achieved their personalized activity goals.
•These findings imply a nuanced relationship between pain relief and the ability to engage in daily activities.
•Addressing the complexity of pain and its impact on activity will be critical in creating patient-centric therapies and a promising area of future research.
•Goal attainment should be more objectively measured in the future as this may enhance therapy compliance and conversations related to overall therapy satisfaction.

References

1. Fishman M, Cordner H, Justiz R, et al. 12-Month Results from Multicenter, Open-Label, Randomized Controlled Clinical Trial Comparing Differential Target Multiplexed Spinal Cord Stimulation and Traditional Spinal Cord Stimulation in Subjects with Chronic Intractable Back Pain and Leg Pain. Pain Pract. 2021; 00: 1– 12. doi: 10.1111/papr.13066. Epub ahead of print.

 
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