Background/Objectives: Over the last 20 years, spinal cord stimulation (SCS) has seen the development of various paresthesia-free paradigms. Recently, a novel modality has emerged (Fast-Acting Sub-perception Therapy, FAST) that engages the surrounding inhibition mechanism of action. We evaluated long-term, real-world outcomes of preferential FAST-SCS use in patients with chronic pain. Methods: In this multi-center, observational, consecutive case series, medical chart data from chronic pain patients preferentially using FAST-SCS (no exclusions) were retrospectively reviewed. Results: Data from 167 patients in 13 European centers were analyzed; 74% of patients suffered from persistent spine pain syndrome type 2 and 87% presented with low back and/or leg pain. At the last follow-up (mean 1.6 years), the numerical rating scale (NRS) overall pain score decreased by 5.1 ± 2.5 points versus baseline, from 8.0 ± 1.2 to 2.9 ± 2.2 (n = 167, p < 0.0001). 87% of patients reported ≥50% pain relief, and 55% were “high responders” with overall NRS pain scores ≤2/10. At the last follow-up, functional disability improved significantly (the Oswestry Disability Index reduced by 29.2 ± 21.5 points, n = 65, p < 0.0001) and patients had a significant gain in quality of life (EQ-5D-5L visual analog scale increased by 52.0 ± 26.9 points, n = 86, p < 0.0001). Results at the 2-year follow-up showed a sustained, substantial reduction in pain; 67% of patients were high responders and the NRS overall pain score decreased by 5.6 ± 2.4 versus baseline (n = 52, p < 0.0001). Conclusions: Our real-world outcomes suggest that in patients with chronic low back and/or leg pain, FAST-SCS therapy provided durable and profound pain relief and led to significant improvements in disability and quality of life.

Die Neuromodulation zur Behandlung chronischer Schmerzen hat in den letzten Jahren an Bedeutung gewonnen. Dies hängt nicht nur mit verbesserter Hardware, sondern auch mit der Entwicklung neuer Implantationstechniken sowie neuer Stimulationsprogramme zusammen. Durch den Einsatz bei axialen Rückenschmerzen, aber auch bei neuen Indikationen wie der diabetischen Polyneuropathie und peripheren Schmerzsyndromen konnte das Indikationsspektrum deutlich erweitert werden. Dieser Artikel hat neben der klassischen epiduralen Rückenmarkstimulation die neuen Indikationen und neuen Techniken zum Thema. Neuromodulation therapies using implants that apply electric currents to modulate the nervous system – such as spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation – are well-established treatment modalities for patients suffering from chronic pain syndromes. The appropriate choice of stimulation site, indications, and neuromodulation system can significantly improve outcomes in patients with a high disease burden, leading to a dramatic increase in health-related quality of life and functionality. Advances in technology and new stimulation settings have expanded clinical indications, allowing for successful treatment of various pain syndromes. Minimally invasive approaches have reduced complication rates and enabled a whole-body, on-label approach for peripheral nerve stimulation. This update aims to provide an overview of surgical approaches, technological developments, and clinical indications for the treatment of chronic pain syndromes with neurostimulation. Article published online: 07 April 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background/Objectives: Evidence on the effectiveness of spinal cord stimulation using fast-acting subperception therapy (FAST-SCS) in patients with persistent spinal pain syndrome (PSPS) remains limited. We evaluated clinical outcomes of FAST-SCS in patients with PSPS types 1 (i.e., non-surgical back pain) and 2 (i.e., failed back surgery syndrome). Methods: Our global, multicenter, retrospective, observational chart review included all consecutive adults with chronic low back and/or leg pain due to PSPS who received SCS with a multimodal device and reported using FAST-SCS at their latest follow-up. Available data from the patients’ medical files, documented by site personnel per their standard of care, were collected and analyzed. Pain intensity was assessed using the numerical rating scale (NRS); percent pain relief (PPR) was recorded where available. Main outcomes included changes in overall pain (NRS) compared to baseline, proportion of patients with ≥50% reduction in overall pain (NRS), proportion of patients with minimal pain (NRS ≤ 2), and high responder rates (PPR ≥ 80%). Data was analyzed for all PSPS patients at the last follow-up, with preliminary analysis of patients who completed 3-year assessments. Results in PSPS type 1 and 2 patients at the last follow-up are also presented. Results: In total, 424 patients (mean age 61.6 ± 13.5 years; 57% female; 61% PSPS type 2) were included. Mean baseline NRS was 8.0 ± 1.4. At the last follow-up (mean 1.6 ± 1.5 years post-implantation), NRS decreased by 5.3 points to 2.7 ± 2.3 (p < 0.0001), 77% of patients achieved ≥50% reduction in pain, 56% reported minimal pain, and 62% were high responders. Similar improvements were observed in the preliminary analysis of 104 PSPS patients who completed the 3-year follow-up, with ≥5-point reduction in the NRS, 77% responder rate, 60% patients with minimal pain, and 70% high responders. The analysis of PSPS type 1 and 2 populations, adjusted for baseline NRS and follow-up durations, showed comparable outcomes. Conclusions: In this global, observational, “as-treated” cohort, favorable real-world outcomes were observed in PSPS patients using FAST-SCS, supporting its use as an effective treatment option in chronic spinal pain management.