Management of Habituation in Spinal Neuromodulation

This session will comprehensively examine habituation, currently the biggest problem facing neuromodulation. Defined as development of inadequate pain relief after acute success, despite appropriate stimulation coverage and that cannot be explained by a hardware-related issue, habituation is the leading cause of device explant. Habituation to neuromodulation interventions is not unique to pain disorders and occurs across other conditions such as tinnitus and movement disorder. This session will explore the various facets of habituation and its impact on neuromodulation interventions. Specifically, a deep dive into the history of habituation, its definition, incidence among different forms of spinal neuromodulation and its impact will be undertaken. Given its far reaching effects on various nervous system processes, its mechanisms will be explored including brain effects and impact on cranial neuromodulation interventions. Finally, best practice strategies to best manage habituation will be reviewed with a reference to future research directions.