Closed-loop SCS and sensing: now and in the future

Authors

• Krishnan Chakravarthy, VA San Diego Healthcare, San Diego, CA
• Vwaire Orhurhu, University of Pittsburgh Medical Center, Williamsport, PA
• Jan Willem Kallewaard, Rijnstate Hospital, Arnhem, Netherlands
• Leonardo Kapural, Carolinas Pain Institute, Winston-Salem, NC
• Alaa Abd-Elsayed, University of Wisconsin, Madison, WI
• Yashar Eshraghi, LSU Health Sciences Center - New OrleansFollow
• Lakshmi Rekha Narra, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
• Priyanka Ghosh, Remedy Medical Group, San Francisco, CA
• Samir Sheth, Sutter Health, Roseville, CA
• David W. Lee, University of California, Irvine, CA
• Rajiv Reddy, University of California San Diego Health Sciences, San Diego, CA
• Lisa M. Johanek, Medtronic Neuromodulation, Minneapolis, MN
• Julia E. Gamache, Medtronic Neuromodulation, Minneapolis, MN
• David A. Dinsmoor, Medtronic Neuromodulation, Minneapolis, MN
• AnneMarie K. Brinda, Medtronic Neuromodulation, Minneapolis, MN

Document Type

Article

Publication Date

6-10-2026

Publication Title

Pain Medicine

Abstract

BACKGROUND: Spinal cord stimulation (SCS) for chronic pain has undergone many advancements over the years, including the introduction of novel stimulation waveforms, expansion to treat new pain conditions, and the more recent implementation of evoked compound action potential (ECAP) controlled, closed-loop (CL) SCS. The ECAP-a measure of neural activation-may be used as a biosignal for adjusting stimulation amplitudes to avoid under- and overstimulation associated with spinal cord movement relative to the SCS lead. CONTENT OVERVIEW: Using ECAPs in a CL system relies on successfully isolating the neural response signal from the relatively large stimulation artifact. A study with the first commercialized CL-SCS device investigated pain relief with low-frequency stimulation within a therapy window described as ranging from initial perception of sensation to discomfort (paresthesia window). In contrast, another commercial system with CL technology includes additional functionality to support consistent therapy with higher frequency stimulation set at or near the perception threshold. This more recently approved CL-SCS system leverages advanced artifact suppression and flexible CL control algorithms to afford dose control for conventional, high-frequency (up to 1200 Hz), and contemporary SCS waveforms. CONCLUSIONS: Here, we discuss the history and motivation for CL systems in SCS and the challenges faced when implementing such technology.

First Page

S35

Last Page

S45

PubMed ID

42268376

Volume

27

Issue

Supplement_1

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Chakravarthy, Krishnan; Orhurhu, Vwaire; Kallewaard, Jan Willem; Kapural, Leonardo; Abd-Elsayed, Alaa; Eshraghi, Yashar; Narra, Lakshmi Rekha; Ghosh, Priyanka; Sheth, Samir; Lee, David W.; Reddy, Rajiv; Johanek, Lisa M.; Gamache, Julia E.; Dinsmoor, David A.; and Brinda, AnneMarie K., "Closed-loop SCS and sensing: now and in the future" (2026). School of Medicine Faculty Publications. 4911.
https://digitalscholar.lsuhsc.edu/som_facpubs/4911
10.1093/pm/pnag039