title: Improving patient experience with spinal cord stimulation: implications of position-related changes in neurostimulation.
abstract: OBJECTIVE
  The objective of this narrative review is to discuss the clinical implications of position-related changes in spinal cord stimulation and technological improvements to better meet patient needs.
  
  
  METHODS
  Keywords applicable to spinal cord stimulation therapy, including paresthesia perception, spinal cord position, lead impedance, and sensor technologies, were searched in the PubMed, EMBASE, and Cochrane Library databases. Literature analysis, combined with extensive clinical experience with spinal cord stimulation therapy, forms the basis of this review.
  
  
  RESULTS
  Fluctuations in paresthesia perception are largely caused by variation in the distance between the fixed electrodes and the spinal cord consequent to patient movement. Patients employ multiple strategies with varying success to manage position-related fluctuations in stimulation perception, which may result in suboptimum therapy delivery.
  
  
  CONCLUSIONS
  A new type of spinal cord stimulation system that incorporates accelerometer technology to automatically adjust stimulation amplitude based on patient position may better meet patient analgesic needs and is in early clinical application.
authors: Pain Management Center, Brigham & Women's Hospital, Boston, Massachusetts, USA; and Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
authors: Edgar
authors: E
authors: Ross
authors: David
authors: D
authors: Abejón
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data; D004553:Electric Conductivity; D006801:Humans; D010292:Paresthesia / Q000523:psychology* / Q000628:therapy*; D017060:Patient Satisfaction; D013116:Spinal Cord / Q000473:pathology; D062187:Spinal Cord Stimulation / Q000379:methods* / Q000523:psychology*