Programming The Synergy Neurostimulation system

The Goal of Programming The primary goal of programming is to superimpose the stimulation or paresthesia pattern over the patient’s pain pattern and to establish the correct stimulation parameters

Stimulation Parameters

Medtronic Leads Family

SingleStim ® SingleStim ® Mode SingleStim®In SingleStim® mode, the two leads are programmed to the same amplitude, pulse width and rate, thereby producing stimulation from one channel –SingleStim ® –SingleStim ® =one channel, namely one set of electrical parameters defining the “content” of the current SingleStim®SingleStim® can run either with single lead or dual leads configuration –SingleStim® –SingleStim® on a single lead= One channel (or one set of electrical parameters) delivered to 1 lead –SingleStim® –SingleStim® on a dual lead= One channel (or one set of electrical parameters) delivered to 2 leads

SingleStim ® Synergy Flexibility: SingleStim ® /SingleLead SingleStim ® 1x4 SingleStim ® (1 lead, and 4 electrodes in SingleStim ® SingleStim ® mode)

SingleStim ® Synergy Flexibility: SingleStim ® /DualLead SingleStim ® 2x4 SingleStim ® (2 leads, with 4 electrodes each, in SingleStim ® SingleStim ® mode)

DualStim ® DualStim ® Mode DualStim ®DualStim ® mode increases programming options because two alternating channels are available. DualStim ®DualStim ® therefore allows for two different stimulation outputs (or sets of electrical parameters) from channel 1 and channel 2 –You can have two different Amplitudes and Pulse Widths on the two channels. –The rate will be the same on channel 1 and 2; this is not a parameter you can vary (with any IPG available on the market)

DualStim ® DualStim ® Mode DualStim ® DualStim ® can run either with one or two leads. Single lead configuration –4 electrodes when using 1 x Pisces, Resume or On-Point or –8 electrodes when using 1 x Octad Dual leads configuration –8 electrodes when using 2 Pisces, 2 Resume, or 1 Specify (Specify has 8 electrodes)

DualStim ® Synergy Flexibility: DualStim ® /SingleLead DualStim ® 1x4 DualStim ® (1 lead, and 4 electrodes in DualStim ® mode)

DualStim ® Synergy Flexibility: DualStim ® /DualLeads DualStim ® 2x4 DualStim ® (2 leads, and 4 electrodes in DualStim mode)

Therapeutic Parameters of Neurostimulation

Why opt for a 2 channel system ? DualStim®DualStim® mode, whether used on one lead or on two leads, allows you to cover a greater surface area succounding the chosen stimulation site –Greater flexibility in generating paresthesia patterns DualStim®DualStim® assists in successfully managing difficult to treat pain conditions, and provides the option to recapture pain relief in response to a change in pain pattern over time SingleStim ® –Post implant, start with SingleStim ® mode (one channel) DualStim ® –If pain relief is not optimized, when using Synergy, you have the option to move on to DualStim ® mode Either post implant, or at a later follow up date

DualStim ® Synergy Flexibility: DualStim ® /SingleLead Cover a greater (vertical) pain area to optimize pain relief for happier patients Allows you to successfully treat a wider range of patients by giving your more options to cover pain DualStim ® 1x4 DualStim ® (1 lead, and 4 electrodes in DualStim ® mode)

DualStim ® Synergy Flexibility: DualStim ® /DualLeads DualStim ® 2x4 DualStim ® (2 leads, and 4 electrodes in DualStim ® DualStim ® mode) Cover a greater (vertical and horizontal) pain area to optimize pain relief for happier patients Use two channels to optimize pain coverage; One channel could have a higher Amp to intensify the parestesia on one side.

Octad Lead Advantages Dual lead coverage with the simplicity of one lead

DualStim ®DualStim ® option to cover the longest vertebral area on multiple pattern Electronic repositioning in case of lead movement Octad Lead Advantages

Programming Algorithm DualStim® 2x4 will maximize flexibility to cover pain in difficult to treat conditions such as prominent back pain or multi-focal pain patterns Pain relief Sub-Optimal? Try DualStim Pain relief Sub-Optimal? Move to Dual Lead Or one Octopolar SingleStim Try DualStim OK Start with 1 Lead SingleStim Sub Optimal Pain Relief? OK

Why opt for a 2 channel system ? Summary DualStim®Synergy’s DualStim® mode allows you to cover a greater surface area succounding the chosen stimulation site With Synergy you do not have to guess the change in pain pattern over time –You adjust to it by using simple programming options DualStim® –Use the Single/DualStim® option to recapture pain relief Synergy’s programming options assist in successfully managing difficult to treat pain conditions, and therefore allow you to successfully treat the broadest range of pain patients

The Synergy Neurostimulation System For the successful treatment of the broadest range of patients with chronic pain