ArticleRegional anesthesia and pain medicine2025
First evidence of a biomarker-based dose-response relationship in chronic pain using physiological closed-loop spinal cord stimulation.
Article in Regional anesthesia and pain medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed.
- Trial
- Molecular and Cellular Mechanisms of Spinal Cord Stimulation: Linking Dorsal Horn Circuits, Glia, and ECAP-Guided Therapy.International journal of molecular sciences · 2026Review
- Spinal cord stimulation: An emerging strategy for chronic pain relief after spinal cord injury.Neural regeneration research · 2026Article
- Electrophysiologic Characteristics of Epidural Spinal Signals in Preclinical Models of Spinal Cord Stimulation.Neuromodulation : journal of the International Neuromodulation Society · 2026Article
- Closed-loop SCS and sensing: now and in the future.Pain medicine (Malden, Mass.) · 2026Review
- Objective, Same-Day SCS Trials with ECAP-Controlled Closed-Loop Therapy: Depth of Response is Maintained from Trial to 12 months.Pain and therapy · 2026Article
- Next-Generation SCS Programming Platform: Enhancing ECAP Fidelity and Objectivity to Improve Patient Experience.Pain and therapy · 2026Article
- Electrophysiological Characteristics of Epidural Spinal Signals in Preclinical Models of Spinal Cord Stimulation.bioRxiv : the preprint server for biology · 2026Article
- The American Society of Pain and Neuroscience (ASPN) Evidence-Based Consensus Recommendations on Programming and Coding Implantable Spinal Cord Stimulation Devices for Treatment of Chronic Intractable Pain.Journal of pain research · 2026Review
- Spinal Cord Stimulation: Mechanisms of Action, Indications, Types, Complications.Journal of clinical medicine · 2025Review
- First Objective Evidence Characterizing Differences in Cervical and Thoracic Spinal Cord Neurophysiology Using ECAP-Controlled Closed-Loop Technology.Pain and therapy · 2025Article
- Overlapping mechanisms of epidural spinal cord stimulation for pain control and movement recovery.Current opinion in neurology · 2025Review
- Significant pain reduction in refractory post-mastectomy pain syndrome with closed-loop spinal cord stimulation: illustrative cases.Journal of neurosurgery. Case lessons · 2025Article
- Can Spinal Cord Stimulation be Considered as a Frontier for Chronic Pain in Diabetic Foot?Pain and therapy · 2025Review
- Neuromodulation in chronic pain management: addressing persistent doubts in spinal cord stimulation.Journal of anesthesia, analgesia and critical care · 2025Review
- The American Society of Pain and Neuroscience (ASPN) Guidelines and Consensus on the Definition, Current Evidence, Clinical Use and Future Applications for Physiologic Closed-Loop Controlled Neuromodulation in Chronic Pain: A NEURON Group Project.Journal of pain research · 2025Review
- Research hotspots and frontiers of neuromodulation technology in the last decade: a visualization analysis based on the Web of Science database.Frontiers in human neuroscience · 2025Review
- Durability of Evoked Compound Action Potential (ECAP)-Controlled, Closed-Loop Spinal Cord Stimulation (SCS) in a Real-World European Chronic Pain Population.Pain and therapy · 2024Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesIn spinal cord stimulation (SCS) therapy, electricity is the medication delivered to the spinal cord for pain relief. In contrast to conventional medication where dose is determined by desired therapeutic plasma concentration, there is lack of equivalent means of determining dose delivery in SCS. In open-loop (OL) SCS, due to the dynamic nature of the epidural space, the activating electric field delivered is inconsistent at the level of the dorsal columns. Recent Food and Drug Administration guidance suggests accurate and consistent therapy delivered using physiologic closed-loop control (PCLC) devices can minimize underdosage or overdosage and enhance medical care. PCLC-based evoked compound action potential (ECAP)-controlled technology provides the ability to prescribe a precise stimulation dose unique to each patient, continuously measure neural activation, and objectively inform SCS therapy optimization.
methodsNeurophysiological indicator metrics of therapy dose, usage above neural activation threshold, and accuracy of SCS therapy were assessed for relationship with pain reduction in over 600 SCS patients.
resultsSignificant relationships between objective metrics and pain relief across the patient population are shown, including first evidence for a dose-response relationship in SCS.
conclusionsHigher dose, more time over ECAP threshold, and higher accuracy are associated with better outcomes across patients. There is potential to optimize individual patient outcomes based on unique objective measurable electrophysiological inputs.
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