Method of neurostimulation of distinct neural structures using single paddle lead to treat multiple pain locations and multi-column, multi-row paddle lead for such neurostimulation
In some embodiments, a paddle lead is implanted within a patient such that the electrodes are positioned within the cervical or thoracic spinal levels. An electrode combination on a first row of electrodes can be determined that is effective for a first pain location with minimal effects on other regions of the body. The first pain location can be addressed by stimulating a first dorsal column fiber due to the relatively fine electrical field resolution achievable by the multiple columns. Then, another electrode combination on a second row of electrodes can be determined for a second pain location with minimal effects on other regions. The second pain location could be addressed by stimulating a second dorsal column fiber. After the determination of the appropriate electrodes for stimulation, the patient's IPG can be programmed to deliver pulses using the first and second rows according to the determined electrode combinations.
1. A method of treating chronic pain in a patient with spinal cord stimulation, wherein (i) the chronic pain includes a first pain component within a first bodily sub-region of the trunk of the patient, (ii) the chronic pain includes a second pain component within a second bodily sub-region of the lower extremities of the patient separated from the first bodily sub-region by intervening bodily sub-regions, (iii) a stimulation lead is implanted within the epidural space of the patient, the method comprising:
selecting from the stimulation lead a first set of stimulation parameters including one or more first active electrode to treat chronic pain in the first bodily sub-region;
selecting from the stimulation lead a second set of stimulation parameters including one or more second active electrode to treat chronic pain in the second bodily sub-region;
wherein the stimulation lead comprises a paddle structure with at least 10 electrodes disposed in at least five mutually adjacent columns and at least two adjacent rows on the paddle structure;
controlling a pulse generator to apply electrical pulses to the patient through the stimulation lead according to the first and second set of stimulation parameters, wherein:
(i) a first electrical field, created by stimulation pulses having the first set of stimulation parameters applied through the first active electrode, has a restricted spatial resolution to stimulate a first set of one or more dorsal column fibers;
(ii) a second electrical field, created by stimulation pulses having the second set of stimulation parameters applied through the second active electrode, has a restricted spatial resolution to stimulate a second set of one or more dorsal column fibers;
wherein, in response to the applied electrical pulses, the patient experiences paresthesia in the first and second bodily sub-regions and the patient experiences minimal sensory effects from the applied electrical pulses in the intervening bodily sub-regions.
2. The method of claim 1 wherein the first set of one or more dorsal column fibers are associated with a first fasciculus of the dorsal column of the patient and the electrical field created by the stimulation pulses restricts the stimulation to the first set of dorsal column fibers associated with the first fasciculus while minimizing stimulation to adjacent dorsal column fibers in the first fasciculus or adjacent dorsal column fibers in another immediately adjacent fasciculus.
3. The method of claim 2 wherein the second set of one or more dorsal column fibers are associated with a second fasciculus of the dorsal column of the patient and the electrical field created by the stimulation pulses restricts the stimulation to the second set of dorsal column fibers associated with the second fasciculus while minimizing stimulation to adjacent dorsal column fibers in the second fasciculus or adjacent dorsal column fibers in another immediately adjacent fasciculus.
4. The method of claim 3 wherein the first fasciculus and the second fasciculus are the same.
5. The method of claim 4 wherein the first fasciculus and the second fasciculus are different.
6. The method of claim 1 wherein the paddle structure is implanted in a lower thoracic vertebral level selected from the group consisting of T8, T9, T10, T11 and T12.
7. The method of claim 1 wherein the paddle structure spans the physiological midline of the patient.