When I was in training, I was taught that “Stims stim,” meaning there wasn’t much difference between spinal cord stimulation (SCS) devices beyond customer service for our patients. Back then, no SCS devices had MRI compatibility, and the only real debate was whether current-driven or voltage-driven stimulation worked better. But over the last 15 years, a lot has changed. Now, SCS technology offers specialized approaches tailored to different types of pain, creating new options for patients in need of long-lasting relief.
At Red Butte Pain Solutions, we stay at the forefront of these advancements to bring you the best in SCS therapy. Today, we’ll explore two leading-edge types: Differential Targeted Multiplex (DTM) stimulation and closed-loop spinal cord stimulation. Each provides unique benefits for chronic pain patients, and understanding how they work can help you make informed decisions about your care. Over the coming weeks, we will also discuss other innovative forms of stimulation to show how each approach meets different patient needs.
What Is Spinal Cord Stimulation?
Spinal cord stimulation is a minimally invasive treatment that involves placing a device near the spinal cord. This device sends electrical pulses to block or change pain signals before they reach the brain, offering a unique way to manage chronic pain that hasn’t responded to traditional treatments. SCS systems are designed to provide long-term relief, and each device can be tailored to the patient’s unique pain profile, offering a personalized approach to pain management.
How Does Differential Targeted Multiplex (DTM) Stimulation Work?
Differential Targeted Multiplex (DTM) stimulation is an innovative advancement in SCS. It was developed from research on glial cells—special cells that support neurons and play a role in pain processing. DTM targets both the spinal cord and these surrounding glial cells, enhancing the effectiveness of pain relief by addressing pain at multiple levels.
The Role of Glial Cells in Pain
Glial cells are cells that surround and support nerve cells in the central nervous system. They play a crucial role in pain processing by affecting inflammation and nerve sensitivity. In chronic pain, glial cells can amplify pain by increasing inflammation. DTM stimulation, by targeting these cells, can reduce inflammation around nerves, potentially reducing pain.
Key Benefits of DTM Stimulation
- Enhanced Pain Relief: DTM targets pain at multiple levels, making it effective for various chronic pain conditions.
- Better Outcomes for Chronic Pain: Studies indicate that DTM can provide significant relief for patients with difficult-to-treat pain.
- Customizable Therapy: DTM is adaptable to the individual needs of each patient, improving comfort and outcomes.
DTM’s focus on both neurons and glial cells gives it a unique approach, aiming to reduce both pain and inflammation. This dual-targeted effect can help patients manage pain better than traditional SCS in certain cases.
What Is Closed-Loop Spinal Cord Stimulation?
Closed-loop spinal cord stimulation is another advanced SCS method that responds dynamically to the patient’s needs. Unlike traditional, open-loop systems that deliver a fixed level of stimulation, closed-loop systems adjust stimulation in real-time based on the body’s feedback. This continuous monitoring helps the device adapt to changes in the patient’s posture, activity, and pain intensity, maintaining consistent pain relief without manual adjustments.
How Closed-Loop Systems Monitor the Body
Closed-loop systems use sensors to monitor nerve responses, detecting the spinal cord’s electrical activity in real time. When a change is detected—like a shift in posture—the device adjusts its output automatically to maintain effective pain management. This ensures that the stimulation remains effective throughout daily activities and varying pain intensities.
Advantages of Closed-Loop Spinal Cord Stimulation
- Consistent Pain Relief: Closed-loop systems deliver stable pain relief, adapting to changes in activity and body position.
- Improved Comfort: By adjusting stimulation in real time, closed-loop systems avoid overstimulation or under-stimulation, making them more comfortable for patients.
- Enhanced Safety: Continuous monitoring helps the device operate safely, reducing the risk of overstimulation-related discomfort.
Closed-loop systems offer personalized, adaptable pain relief, making them ideal for active patients or those whose pain varies throughout the day.
Comparing DTM and Closed-Loop Stimulation
These two advancements—DTM and closed-loop stimulation—offer distinct benefits for chronic pain patients. While both provide effective pain relief, they excel in different scenarios.
| Feature | DTM Stimulation | Closed-Loop Stimulation |
|---|---|---|
| Primary Target | Glial cells and spinal cord | Spinal cord with real-time feedback |
| Adaptability | Customizable to patient’s pain levels | Real-time adjustments to patient activity |
| Pain Relief | High efficacy for complex, treatment-resistant cases | Consistent relief across daily activities |
| Research Backing | Supported by studies on glial cells | Proven for dynamic, adaptable relief |
DTM’s focus on targeting glial cells and the spinal cord makes it well-suited for patients with glial-involved pain. Closed-loop’s real-time feedback capabilities make it ideal for patients who need adaptable stimulation for varied activities and pain intensities.
Who Can Benefit from DTM and Closed-Loop Stimulation?
Spinal cord stimulation benefits patients with chronic pain who have not found relief through other methods. It works well for pain related to nerve damage, back pain, and neuropathic pain. Here’s a closer look at which patients may benefit most from each approach:
When to Choose DTM Stimulation
DTM stimulation is particularly effective for complex or treatment-resistant pain. For patients with suspected glial cell involvement, DTM offers a promising option by targeting the cells contributing to pain and inflammation.
When to add Closed-Loop Stimulation
Closed-loop systems suit patients with active lifestyles or those whose pain fluctuates with movement or daily activities. For these patients, real-time feedback ensures they receive consistent relief, no matter their level of activity. When coupled with DTM and other forms of stimulation patients see more consistent results with longer battery life, less time spent adjusting their device programming and parameters, and improved satisfaction with their therapy.
The Process of Starting Spinal Cord Stimulation
At Red Butte Pain Solutions, we provide a structured approach to spinal cord stimulation to ensure you receive the best care. Our process includes:
- Initial Consultation: We assess your pain history and determine the most suitable SCS approach.
- Trial Period: A temporary stimulator is placed to see how it affects your pain.
- Implantation: If the trial is successful, the permanent device is implanted under the skin.
- Follow-Up Care: Regular follow-ups help monitor device function and adjust settings as needed.
Risks and Considerations for SCS
Like all procedures, spinal cord stimulation has some risks. Common side effects can include mild discomfort, temporary pain at the implant site, or infection. However, these risks are minimal, especially when the procedure is performed by an experienced provider.
The Future of Spinal Cord Stimulation
Advancements in spinal cord stimulation technology promise a bright future for chronic pain patients. Research continues to enhance safety, improve efficacy, and make SCS accessible to more patients. New technologies, like DTM and closed-loop systems, demonstrate how innovative approaches can improve patient outcomes, and we are excited to see where future developments will lead.
Conclusion
At Red Butte Pain Solutions, we are committed to helping you find the best treatment for your chronic pain. Our goal is to provide you with effective pain management options that align with your needs. Stay tuned as we continue exploring other forms of stimulation in the coming weeks, and reach out if you’re ready to take the next step toward lasting pain relief.