Spinal Cord Stimulation: Engineering Approaches to Clinical and Physiological Challenges

Spinal cord stimulation is an effective therapy for the management of chronic pain with historical origins dating back to the 1960s. The therapy consists of electrical stimulation of the spinal cord to 'mask' pain. One effect of stimulation is generation of tingling paresthesia in the patient, and overlap of the paresthesia with the pain is important to successful therapy. Clinical and anatomical challenges to successful and durable concordant paresthesia include: contact impedance changes, lead migration, clinical programming time requirements, unknown anatomic variables, and optimal lead design. In this chapter we review these challenges, the principles guiding engineering solutions and trade-offs, and the use of computational tools to guide design of system components. Topics include a historical overview, stimulation waveform and clinical effects of waveform parameters such as pulse width, voltage vs. current control, multiple-source systems, real-time programming methods, contact size and spacing, use of field potentials for electrical imaging, modeling methods, and others.