U.S. patent number 3,822,708 [Application Number 05/312,935] was granted by the patent office on 1974-07-09 for electrical spinal cord stimulating device and method for management of pain.
This patent grant is currently assigned to Clinical Technology Corporation. Invention is credited to Serge Zilber.
United States Patent |
3,822,708 |
Zilber |
July 9, 1974 |
ELECTRICAL SPINAL CORD STIMULATING DEVICE AND METHOD FOR MANAGEMENT
OF PAIN
Abstract
Intractable pain that is transmitted by the spinal cord and
sensed by the human body is suppressed by implanting an electrode
carrying device near a nerve bundle in the spinal cord. The device
is constructed of an electrical insulating substance inert to the
body fluids and tissue and carries electrodes for supplying
electric current to the spinal cord thereby suppressing the sensed
quantity of pain. These electrodes are in aligned, spaced
relationship with the alignment extending transversely of the nerve
bundle. A switch may be positioned within the body and used to
supply the current to certain of the electrodes in response to the
quantity of pain sensed thereby controlling same by varying the
area of the spinal cord affected.
Inventors: |
Zilber; Serge (Kansas City,
MO) |
Assignee: |
Clinical Technology Corporation
(Kansas City, MO)
|
Family
ID: |
23213658 |
Appl.
No.: |
05/312,935 |
Filed: |
December 7, 1972 |
Current U.S.
Class: |
607/46; 607/59;
607/72; 607/61 |
Current CPC
Class: |
A61N
1/372 (20130101); A61N 1/36071 (20130101) |
Current International
Class: |
A61N
1/372 (20060101); A61N 1/375 (20060101); A61N
1/32 (20060101); A61N 1/34 (20060101); A61m
001/36 () |
Field of
Search: |
;128/419R,418,404 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Lowe, Kokjer, Kircher
Claims
Having thus described my invention, I claim:
1. A method of suppressing pain by stimulating a preselected spinal
cord level, said method comprising the steps of:
positioning at least three electrodes in a single row in at least a
portion of said spinal cord substantially longitudinal to the
length of said spinal cord along the natural separation of said
spinal cord,
generating electrical energy in a source of electric power, and
electrically connecting said electrodes with the source of electric
power, thereby establising a plurality of electric dipoles having
their fields oriented longitudinally with said spinal cord.
2. The method as in claim 1 including the step of varying the area
of said spinal cord being managed in accordance with the amount of
pain sensed by the body.
3. The method as in claim 2 wherein said area varying step includes
the step of providing electric current to preselected combinations
of said electrodes.
4. A device for managing pain, said device being of the type that
is implantable in the body within the spinal cord and adjacent a
nerve transmitting intractable pain, said device including
an electrode carrying member constructed of electrical insulating
material and of the type that will not be rejected by the body,
the electrode carrying member having a surface portion extending
substantially perpendicular thereto, said perpendicular surface
having a plurality of apertures defined therein, the perpendicular
surface and the apertures facilitating the attachment of the
electrode carrying member to said spinal cord, and the
perpendicular surface facilitating post operative sealing of the
dura incision,
a plurality of electrodes positioned longitudinally in a spaced
apart relationship in said member with a surface of each of said
electrodes being located substantially near the exterior of said
member to enable electric current flow between said electrode, said
surfaces of said electrodes having a predetermined portional
surface area to achieve a preselected current density,
an electrical conductor extending from said electrodes, and
means for supplying electrical power to said conductors to thereby
cause a current flow between said electrodes, thereby establishing
electric fields oriented longitudinally along the spinal cord.
5. The combination as in claim 4 wherein said device includes an
odd number of at least three electrodes, a center electrode, said
center electrode having a larger area and operable to achieve a
predetermined current density between said adjacent electrodes when
a current flows between certain ones of said adjacent electrodes
and said center electrodes.
6. The combination as in claim 5 including means for selectively
supplying current to certain ones of said electrodes in accordance
with the quantity of pain sensed, said selective current supplying
means thereby permitting the controlling of pain by varying the
area of said spinal cord being managed.
7. The combination as in claim 4 wherein said device comprises an
odd number of electrodes arranged longitudinally in a spaced apart
relationship,
a first group of electrodes connected together said first group
being comprised of the first, third, and similarly odd numbered
electrodes,
a second group of electrodes connected together, said second group
being comprised of the second, fourth, and similarly even numbered
electrodes,
said first group and said second group operative to form an even
number of longitudinally aligned electric dipoles when excited by
said energy source, said device thereby concentrating electric
current in preselected regions of the spinal cord to minimize
unnecessary spinal cord current spread and root pain associated
therewith.
Description
BACKGROUND AND BRIEF DESCRIPTION OF THE INVENTION
Within the past several years rapid advances have been made in
medical apparatus for controlling pain in which no single nerve
fiber is responsible for the passing of the pain sense (intractable
pain) by the human body. This apparatus normally involves the
implantation of an elelctrode within the body to electrically
stimulate the area of the spinal cord nearest the pain sensing
nerve. The electrical stimulation of the spinal cord is analogous
to the "gate control theory" of pain, and uses electrical energy to
prevent the transmission of the sensed pain. That is, the pain
relief which follows peripheral nerve stimulation according to the
"gate control theory" is due to the inhibition of the small
myelinated or unmyelinated fibers by electrically activating the
large myelinated fibers. Prior to the use of this type apparatus,
the only method of controlling intractable pain was through massive
doses of "pain killing" drugs, which required larger doses as the
pain became more intense. Also selective nerve surgery was possible
but in both cases several undesirable effects were induced with a
patient being unable to live a normal life.
The medical apparatus normally based on the "gate control theory"
acts as an "on-off" switch. Stated another way, by activating the
apparatus, the nerves will not pass any sensed signals on the
length thereof. Still unexplained is the lasting effect of
stimulation e.e., the lack of pain sensation continues for some
time after turning the switch "0ff." Further, motor function of the
body may be adversely affected because of the total blocking of the
nerve sensation. However, the utilization of such a device is still
preferreable to other known methods of managing intractable
pain.
The present invention is an implantable electrode carrying device
having five aligned electrodes carried thereon. This electrode
alignment is positioned longitudinally on the spinal cord and
transversely to the nerves entering the cord and carrying the
sensed intractable pain. An electrical current is passed through
certain ones of the electrodes, into a portion of the juxtaposed
spinal cord area, and into another electrode acting as a ground.
The passage of the current into the portion of the spinal cord (or
selective tracks thereof) acts to block the sensed intractable pain
and yet allow the passage of other sensation. Should the pain
increase, current may be passed through certain other ones of the
electrodes, into a larger portion of the passing nerve being
stimulated, and onto the ground electrode. Accordingly, the volume
of spinal cord being blocked by electric current is related to the
pain being sensed by the body.
One of the primary objects of this invention is to provide unique
device implantable in the spinal cord of an animal that will
electrically stimulate a segment of the spinal cord to reduce
sensed intractable pain in response to the amount of pain being
sensed.
Another object of this invention is to provide a device of the
character described having electrodes within a carrying member with
the electrodes constructed so as to maintain a suitable current
density in proportion to the distance from the emitting
electrodes.
A further object of this invention is to provide unique device to
control the relative amount of sensed intractable pain without the
necessity of directly contacting the nerve bundle passing said
sensed intractable pain.
As a further object of the invention unique device is provided that
is implantable and operable to be sutured to the spinal cord for
maintaining the apparatus in its relative location with minimal
adverse effects to the spinal cord.
Another object of this invention is to provide a unique electrode
carrying member of such configuration as to be easily implanted
within the body's spinal cord for the control of intractable
pain.
These and other objects of the invention, together with the
features of novelty appurtenant thereto, will appear in the course
of the following description.
DETAILED DESCRIPTION OF THE INVENTION
In the accompanying drawings which form a part of this
specification and are to be read in conjunction therewith and in
which like reference numerals are employed to indicate like parts
in various views:
FIG. 1 is a perspective view showing a form of an electrode
carrying member embodying the present invention;
FIG. 2 is a front elevational view of the electrode carrying member
of FIG. 1 with portions of the member being in section;
FIG. 3 is an end elevational view of the carrying member of FIG.
1;
FIG. 4 is a bottom plan view of a carrying member of the present
invention showing the location and configuration of the electrodes
thereon;
FIG. 5 is a view of the carrying member of FIG. 4 with a possible
wiring interconnection between the electrodes being shown;
FIG. 6 is a view similar to FIG. 5 but an alternative electrode
configuration and wiring interconnect;
FIG. 7 is a block diagram of a suitable circuit for providing the
electrical current necessary for use with an electrode carrying
member of the present invention;
FIG. 8 is a perspective view of the carrying member shown in FIG. 1
being implanted in the spinal cord and with certain portions of the
spinal cord being shown in section; and
FIG. 9 is a side elevational view of the carrying member shown in
FIG. 8 being implanted in the spinal cord.
Turning now more particularly to the drawings and with special
reference to FIGS. 1-3, it is seen that the electrode carrying
device is generally represented by the numeral 10. The device
includes a flat elongated member 11 having rounded end portions
11a. A vertically oriented member 12 is integrally formed with the
flat lower member 11 and substantially lies along the longitudinal
center line of flat member 11. A plurality of apertures 13 will
extend through the vertical portion 12 and will be utilized to
properly locate the device when implanted. It is contemplated that
the device will be constructed of a commercially available material
such as silicone rubber and that it will not be rejected by the
body when implanted therein.
The lower surface 11b (see FIGS. 4-6) of the device is generally
oblong in shape and will have a center electrode 14 fixedly located
therein by a conventional molding process. It is contemplated that
electrode 14 will be a disc shaped metallic member having a smooth
outer surface and a fixed interconnect with a suitable electrical
wire conductor described later. Four additional electrodes 15, 16,
17 and 19 are evenly disposed on either side of the center
electrode 14 with electrode pair 15 and 16 being located on one
side of the center electrode 14 while the pair 17 and 18 are
located on the other. The latter four electrodes (in FIGS. 4 and 5)
are smaller (approximately one half sized) in area and will be of
the disc shape construction mentioned above with respect to
electrode 14. As shown in FIG. 2, each electrode will also have its
inner surface circumscribed by upturned rims 18a. These rims
cooperate in the optimum locating and attaching the electrodes
interiorly of lower surface 11b.
A flexible silicone rubber conduit 19 will extend through an
aperture in the upper surface of the vertical member 12 of the
device 10. Each one of the electrodes (14-18) may be interconnected
with a separate conductor 20 (see FIG. 2) with the conductors
bunched together and running out of the conduit 19. It should be
noted that there are alternative ways in which the electrodes may
be connected and that numeral 20 is used generally to designate a
plurality of conductors which may interconnect with the electrodes.
In the embodiment shown in FIGS. 4 and 5, the area of the center
electrode 14 is constructed so that it is twice the size of the
areas of the electrodes 15-18. Further the distance from electrode
14 to electrodes 16 and 17 is twice that between electrodes 15, 16,
17 and 18. This latter electrode configuration is used to
concentrate current density along the center line of the unit.
An alternative conductor interconnection is shown in FIGS. 5 and 6.
For example, the FIG. 5 representation indicates that the
electrodes 15 and 18 may be bussed together by conductor 21 while
the electrodes 16 and 17 are interconnected by conductor 22.
Finally, the center electrode 14 and the two bus type connectors 21
and 22 will be interconnected with the leadin conductors 20 and are
tied to the later described receiver.
In FIG. 6 it is indicated that electrodes 14, 15 and 18 may be
interconnected by bus connectors 23 and further that the two
electrodes 16 and 17 are again interconnected by bus 22. In the
later embodiment, the two bus connectors 22 and 23 are again
interconnected with the leadin conductors 20. Additionally, the
size of all of the electrodes 14-18 in FIG. 6 are substantially
equal and are therefore evenly distributed along the longitudinal
center line of the lower surface 11b in order to obtain uniform
current density. It has been found that the area of electrodes 16
and 17 may be made slightly larger than electrodes 14, 15, and 18
to equalize current density within the electrodes. In any event
with the electrode configuration as shown in FIG. 6, this field
will consist of four magnetic dipoles serving to concentrate
currents in the dorsal region of the spinal cord, thereby avoiding
unnecessary root pain which occurs with prior art devices. As
suggested above, the electrode material will be chosen to provide a
low electrical resistance (such as platinum) and will be of such a
nature that it will not be rejected by adjacent body tissues.
Additionally, all conductors passing through the conduit 20 and
interiorly of the body will be insulated from each other and yet be
flexible. Accordingly, polytetrafluoroethelene may be used to coat
the conductors which will eventually terminate in the receiver.
The actuating current is supplied to the device and by the
circuitry shown in FIG. 7. As shown, a radio frequency transmitter
generally indicated by the numeral 30 is used to transmit a
rectangular pulse of approximately 250 miliseconds in width with a
repetition rate of from 5 to 200 pulses per second. The radio
frequency transmitter may be of a conventional design with the
output of same being delivered to an antenna or output coil 31 and
with the output signal emanating therefrom.
As indicated, the electrodes are interconnected with conductors
which are in turn interconnected with a receiving device generally
indicated by the numeral 62. The receiver 62 will include a
receiver coil and RF detector 64 and a filter 66. The filtered
output may be then delivered to reed switch 68. It is contemplated
that this receiver, including the reed switch structure (if used)
will be encapsulated and covered by a silicone rubber covering. The
receiver is located under the skin and in such a position so as to
be easily reached by the individual himself or certainly by an
attending physician. In any event, when the signal is received by
receiver 62, detected in 64 and filtered in 66, the resultant
current flow will be through the reed switch 68 and out on either
terminal 70 or 72 depending upon the location of the switch
contact. Terminal 74 is considered to be the ground or neutral
terminal and is ususlly interconnected with the current collecting
or indifferent electrode in device 10.
The installation procedure would normally require a laminectomy
involving the removal of the lamina of a vertebra with the
electrode assembly 10 being placed under the dura in the spinal
cord 76. It may be assumed for this discussion that the intractable
pain sensed by the body is being transmitted along the nerve 78.
The dura 80 of the spinal cord 76 is surgically separated and the
device 10 positioned along the natural separation 82 of the spinal
cord so that the center line of the device (through the centers of
the electrodes 14-18) is substantially transversed to the
longitudinal center line of nerve 78. The vertical height of the
lower member 11 is selected so that it may be positioned between
the dura 80 and the arachnoid 84 without discomfort. Also, the
vertical height of the apertures 13 will be such that the device 10
may be sutured to the dura 80.
When the device shown in FIG. 4 is to be utilized, the conductors
20 of the electrode 14 passes through the device 10 and connects
with terminal 74 (if the optional reed switch is used). Similarly,
conductors will lead from the electrodes 15 and 16 and will tie in
with switch terminals 70 and 72 respectively. With the reed switch
in position so that its switch arm contact is interconnected with
terminal 72, the electrode 16 will be energized with a current flow
resulting from electrode 16, through the spinal fluid and to the
center or return electrode 14. As a result, the current flow is
suitable to suppress the intractable pain being passed through
nerve 78. If the switch 68 is not used, then the conductors 20
connect directly with filter output.
If the pain is still present, switch 68 may be activated to move
its contact to the terminal 70 position which interconnects with
the appropriate conductor 20 to electrode 15. Since the distance
from electrode 15 to the return electrode 14 is greater, an
increased area of the spinal cord is accordingly stimulated by the
current flow between the terminals 15 and 14. As a result of the
utilization of the end and the center electrodes (15 and 14), had,
there is a greater capacity to block the pain. Should the
intractable pain lessen, switch 68 may again be activated and the
current will pass back through the terminal 72 and electrodes 16
and 14. Accordingly, the amount of blocking in response to the
amount of pain sensed is controlled by area of nerve 78 being
affected by the current flow therethrough. It should be pointed out
that this embodiment will function equally well with electrodes 17
and 18 replacing the electrodes 15 and 16 described above.
The operation of the electrode configuration in FIG. 5 is similar
to that described above except that conductor 22 is interconnected
with terminal 72 while conductor 21 is interconnected with terminal
70. As a result, a greater spinal cord area is affected in the FIG.
5 embodiment that by that disclosed in FIG. 4. Since more spinal
cord area is controlled, the ability to block increased pain is
likewise increased.
The FIG. 6 embodiment effectively eliminates the use of switch 68
in that conductor 22 could be interconnected with terminal 74 while
conductor 23 could be connected with the terminals 70 or 72. Thus a
pain sensed is again subjected to substantially the entire
longitudinal dimension of the device when current is applied
through the two above mentioned terminals.
Finally, it should be understood that the transmitter will include
a suitable magnetic device to enable reed switch 68 to be
controlled if such a switch is used. In other words, the switch arm
of reed switch 68 will be movable from a location externally of the
body. The transmitter will simply be placed over the implanted
receiver so that the proper energizing and switch terminal
selection is easily made in accordance with the degree of pain
being experienced.
From the foregoing, it will be seen that this invention is one well
adapted to attain all the ends and objects herein set forth,
together with other advantages which are obvious and which are
inherent to the structure.
It will be understood that certain features and subcombinations are
of utility and may be employed without reference to other features
and subcombinations. This is contemplated by and is within the
scope of the claims.
As many possible embodiments may be made of the invention without
departing from the scope thereof, it is to be understood that all
matter herein set forth or shown in the accompanying drawings is to
be interpreted as illustrative and not in a limiting sense.
* * * * *