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

Abstract

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 system for treating pain in a patient using spinal cord stimulation, wherein (i) the pain includes a first pain component within a first bodily sub-region of a trunk of the patient, (ii) the pain includes a second pain component within a second bodily sub-region of lower extremities of the patient separated from the first bodily sub-region by intervening bodily sub-regions, the system comprising:
 a paddle structure adapted to be implanted within epidural space of the patient with the paddle structure having electrodes disposed in at least four mutually adjacent columns and at least two adjacent rows on the paddle structure;   a pulse generator that is electrically coupled to the paddle structure and that is programmable to deliver pulses to a spinal cord of the patient using the electrodes of the paddle structure   a non-transient computer-readable medium with instructions stored thereon that, when executed, cause the pulse generator to:   (i) generate a first electrical field, created by stimulation pulses having a first set of stimulation parameters including one or more first active electrode to treat pain in the first bodily sub-region, the first set of stimulation parameters applied through the first active electrode, has restricted spatial resolution to stimulate a first set of one or more dorsal column fibers; and   (ii) generate a second electrical field, created by the stimulation pulses having a second set of stimulation parameters including one or more second active electrode to treat the pain in the second bodily sub-region, the second set of stimulation parameters applied through the second active electrode, has the restricted spatial resolution to stimulate a second set of one or more dorsal column fibers;   wherein, in response to the program, the patient experiences paresthesia in the first and second bodily sub-regions and the patient experiences minimal sensory effects from applied electrical pulses in the intervening bodily sub-regions.   
     
     
         2 . The system of  claim 1  further comprising a programmer device capable of programming the pulse generator. 
     
     
         3 . The system of  claim 1  wherein the first set of one or more dorsal column fibers are associated with a first fasciculus of a 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 the stimulation to adjacent dorsal column fibers in the first fasciculus or adjacent dorsal column fibers in another immediately adjacent fasciculus. 
     
     
         4 . The system of  claim 1  wherein the second set of one or more dorsal column fibers are associated with a second fasciculus of a 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 the stimulation to the adjacent to the dorsal column fibers in the second fasciculus or adjacent dorsal column fibers in another immediately adjacent fasciculus. 
     
     
         5 . The system of  claim 1  wherein the paddle structure is configured to spans a physiological midline of the patient. 
     
     
         6 . A method of treating pain in a patient with spinal cord stimulation, wherein i) the pain includes at least two bodily sub-regions of the patient and the bodily sub-region of the patient comprises upper extremities, lower extremities or a trunk of the patient, ii) a paddle lead implanted within epidural space of the patient, the method comprising
 selecting a set of stimulation parameters including at least one active electrode combination to treat the pain in the bodily sub-region, wherein the paddle lead comprises a plurality of electrodes disposed in at least four mutually adjacent columns and at least two adjacent rows on the paddle structure; and   controlling a pulse generator to generate electrical pulses and to apply electrical pulses to the patient through the paddle lead according to the stimulation parameters, wherein:
 an electric field, created by stimulation pulses applied through the active electrode combination, has a restricted spatial resolution to stimulate one or more dorsal column fibers associated with the bodily sub-region without causing the stimulation of the dorsal column fibers associated with other bodily regions, wherein, in response to applied electrical pulses, the patient experiences paresthesia in the bodily sub-region with minimal sensory effects from the applied electrical pulses in other the bodily regions. 
   
     
     
         7 . The method of  claim 6  wherein the active electrode combination is moved laterally such that the electric field migrates across a dorsal column of the patient providing perceived stimulation of the bodily sub-region of the patient, wherein the sub-region is associated with lateral segmentation of one or more fasciculus of the dorsal column of the patient. 
     
     
         8 . The method of  claim 6  wherein the bodily sub-regions of the patient are the trunk and the lower extremities. 
     
     
         9 . The method of  claim 6  wherein the bodily sub-regions of the patient are the trunk and the upper extremities. 
     
     
         10 . The method of  claim 6  wherein the paddle structure is positioned such that it spans one vertebral segment 
     
     
         11 . The method of  claim 6  wherein the paddle structure is positioned epidurally in a lower thoracic vertebral level of the patient. 
     
     
         12 . The method of  claim 6  wherein the paddle structure is positioned epidurally in an upper cervical vertebral level of the patient. 
     
     
         13 . A method of treating pain in a patient using spinal cord stimulation, the method comprising:
 operating a programming device to control stimulation settings of a pulse generator, wherein (i) the pulse generator is electrically coupled to a stimulation paddle lead, (ii) the stimulation paddle lead is capable of being implanted within epidural space of the patient, the stimulation paddle lead comprises a structure having a plurality of electrodes disposed in at least four mutually adjacent columns and at least two adjacent rows on the structure; and   selecting at least one active electrode combination to define a stimulation therapy for the patient, wherein application of electrical stimulation using the selected one active electrode combination applies paresthesia to at least two sub-regions of a bodily region of the patient and does not cause paresthesia outside of the sub-regions or in intervening sub-regions.   
     
     
         14 . The method of  claim 13  wherein the structure spans physiological midline of the patient. 
     
     
         15 . The method of  claim 13  wherein the selected active electrode combination is selected from electrode combinations that is associated with any one of fasciculi of a dorsal column of the patient.