title: Clinical Paresthesia Atlas Illustrates Likelihood of Coverage Based on Spinal Cord Stimulator Electrode Location.
abstract: OBJECTIVE
  Concordant paresthesia coverage is an independent predictor of pain relief following spinal cord stimulation (SCS). Using aggregate data, our objective is to produce a map of paresthesia coverage as a function of electrode location in SCS.
  
  
  METHODS
  This retrospective analysis used x-rays, SCS programming data, and paresthesia coverage maps from the EMPOWER registry of SCS implants for chronic neuropathic pain. Spinal level of dorsal column stimulation was determined by x-ray adjudication and active cathodes in patient programs. Likelihood of paresthesia coverage was determined as a function of stimulating electrode location. Segments of paresthesia coverage were grouped anatomically. Fisher's exact test was used to identify significant differences in likelihood of paresthesia coverage as a function of spinal stimulation level.
  
  
  RESULTS
  In the 178 patients analyzed, the most prevalent areas of paresthesia coverage were buttocks, anterior and posterior thigh (each 98%), and low back (94%). Unwanted paresthesia at the ribs occurred in 8% of patients. There were significant differences in the likelihood of achieving paresthesia, with higher thoracic levels (T5, T6, and T7) more likely to achieve low back coverage but also more likely to introduce paresthesia felt at the ribs. Higher levels in the thoracic spine were associated with greater coverage of the buttocks, back, and thigh, and with lesser coverage of the leg and foot.
  
  
  CONCLUSIONS
  This paresthesia atlas uses real-world, aggregate data to determine likelihood of paresthesia coverage as a function of stimulating electrode location. It represents an application of "big data" techniques, and a step toward achieving personalized SCS therapy tailored to the individual's chronic pain.
authors.affiliation: Orange County Neurosurgical Associates, Mission Viejo, CA, USA.
authors.forename: Alexander
authors.identifier: http://orcid.org/0000-0003-4760-0188
authors.initials: A
authors.lastname: Taghva
authors.affiliation: Health Economics Outcomes Research, St. Jude Medical, Sylmar, CA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Karst
authors.affiliation: Field Clinical Engineering, St. Jude Medical, Sylmar, CA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Underwood
mesh_terms: D000328:Adult; D000368:Aged; D001271:Atlases as Topic; D004567:Electrodes, Implanted / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000175:diagnosis / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000295:instrumentation* / Q000379:methods* / Q000592:standards
keywords: Spinal cord stimulation; chronic pain; neuropathic pain; paresthesia