Pain Unfiltered · American Society of Pain & Neuroscience

Are All Closed Loops Created Equal?

November 4, 2024·43 min

Patrick Buchanan and Timothy Deer open with a reflection on the Nashville Aspen Collaborative Pain Summit. The mood is upbeat. They describe a room that brought together orthospine, neurosurgery, interventional radiology, interventional pain, anesthesiology, physiatry, APPs, fellows, and industry. The emphasis is collaboration, not turf. The summit comes across as a place where real problems can be discussed without much ceremony. The hosts treat that as groundwork for the July meeting in Miami. From there, the episode turns to closed-loop stimulation and the technical question of what counts as a biomarker in this system. The answer centers on ECAPs. The conversation explains ECAPs as a real-time surrogate for how the spinal cord responds to electricity. That matters because the field is trying to move away from programming by feel or by rep experience. Instead, it is trying to define a dose. That dose is framed as a relationship between electrical response and individual physiology. The episode keeps coming back to the fact that physiology is not fixed. Pathology, genetics, and possibly other factors can shift the response curve. The hosts and guest treat that as a real change in how stimulation is managed. They talk through the idea that clinicians can map sensitivity instead of simply adjusting after failure. The episode also links that approach to durability, asking what happens when a patient loses efficacy over time. Retrospective data is used to support the argument. The conversation says that prior patient responses can help predict what dose of electricity may be needed next. That gives the field a way to think about improvement in a more measurable and reproducible way. The discussion stays clinical, but it never gets stiff. Questions are asked plainly and the guest is given room to explain the mechanism. The show treats the technical language as part of the work, not as decoration. A steady thread through the episode is simplification of dense material. The guest is thanked for helping make the subject easier to follow. Mentorship and publication history come up near the end, which gives the segment a collegial finish. The episode closes by looking forward to more evidence. It leaves the sense that closed-loop stimulation is getting easier to define, not because it is simple, but because the field is finally naming the variables it has been adjusting all along.

As heard by us

A dense but useful look at closed loop stimulation, ECAP guided dosing, and why electrical dose may need to change over time.

Pain Unfiltered ties a recent collaborative summit to a plainspoken case for closed loop stimulation. The strongest stretch is ECAP guided dosing, which treats spinal cord stimulation as something measured and adjusted, not guessed at.

Read the full review in PlayNext →

Why you'd press play

You want the argument behind closed-loop spinal cord stimulation, not just the buzzword.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify