The following is a summary of “Improvements in Therapy Experience with Evoked Compound Action Potential Controlled, Closed-Loop Spinal Cord Stimulation – Primary Outcome of the ECHO-MAC Randomized Clinical Trial,” published in the July 2024 issue of Pain by Will et al.
Spinal cord stimulation (SCS) is an established method for managing chronic neuropathic pain, but variable electrode spacing can lead to inconsistent stimulation and suboptimal patient outcomes.
Researchers conducted a retrospective study evaluating a novel evoked compound action potential (ECAP)-controlled, closed-loop (CL) SCS algorithm by comparing it with traditional open-loop (OL) SCS, using reduction in overstimulation intensity as a perceptual measure.
They assessed participants based on the sensation during daily activities using a Likert scale for both CL and OL SCS. A total of 42 subjects were involved, and reduction in sensation was the primary outcome metric. The study compared the consistency of SCS doses by measuring variability in ECAP amplitude between CL and OL SCS.
The result showed that 97.6% of subjects experienced reduced sensation with CL compared to OL SCS in Intent-to-Treat analysis. The primary objective was achieved, with the lower confidence limit (87.4%) surpassing the 50% performance goal (P< 0.001). Of the subjects, 88.1% preferred the CL SCS, while 11.9% preferred the OL SCS. The ECAP amplitude variability was significantly lower with CL SCS (SD: 8.72 µV) compared to OL SCS (SD: 19.95 µV).
Investigators concluded that the ECAP-controlled, CL SCS algorithm significantly reduced unwanted sensations and provided patients with a more consistent and favored SCS experience.
Source: jpain.org/article/S1526-5900(24)00596-0/abstract
