Burst and Tonic Spinal Cord Stimulation: Different and Common Brain Mechanisms

An Observational Case Series of Spinal Cord Stimulation Waveforms Visualized on Intraoperative Neuromonitoring

“…Studies have looked at mechanism of action of some of the newer established waveforms. One study concluded that BurstDR differs from traditional tonic stimulation secondary to not activating spinal Gabaergic mechanism , while another concluding that both tonic and BurstDR modulate descending inhibitory pain pathways, but BurstDR has more of an effect on the anterior cingulate cortex of the brain . Other studies have postulated mechanisms of BurstDR occurring secondary to activation of the medial pain pathways, as opposed to the accepted lateral pathway stimulation accepted as a mechanism in SCS .…”

Conventional and Novel Spinal Stimulation Algorithms: Hypothetical Mechanisms of Action and Comments on Outcomes

“… Present “working hypotheses” for mechanisms behind effects of burst stimulation of the spinal cord (adapted from De Ridder and Vanneste 2015 ). Burst SCS is hypothesized to especially modulate the activation of the medial (affective/attentional) pathway (on the right in the figure).…”

“…In a very recent study, De Ridder and Vanneste presented data from five patients undergoing conventional, burst and sham stimulation. In a source‐localized EEG subtraction and conjunction analysis, they showed that burst and conventional stimulation share activation of some cortical areas such as the pregenual anterior cingulate cortex while only burst SCS reduced the connectivity between the dorsal anterior cingulate and the parahippocampal cortices.…”

Are 10 kHz Stimulation and Burst Stimulation Fundamentally the Same?

“…Indeed cingulotomies can reduce pain suffering without reducing pain intensity . It is clear that the ascending pain evoking and descending pain inhibitory pathways need to interact is some way, and it has been suggested that these interactions are dynamically changing depending on the context , and that it is ultimately the balance between pain input and pain suppression that results in whether someone feels pain or not, both in neuropathic , and fibromyalgia pain . The exact anatomical and functional connectomics in pain have yet to be unraveled, but both structural (i.e., anatomical) and functional (i.e., resting state) MRI studies in pain demonstrate complex interactions between somatosensory cortex, cingulate cortex, insula, amygdala, thalamus and frontal cortex .…”