High Frequency 10 kHz Spinal Cord Stimulation as a First Line Programming Option for Patients With Chronic Pain: A Retrospective Study and Review of the Current Evidence

Abstract

IntroductionNeuromodulation is an evolving and increasingly popular therapy for chronic pain management. Recent data suggest that novel waveforms have demonstrated greater benefit over traditional spinal cord stimulation (SCS). The authors conducted a retrospective review of patients undergoing high-frequency 10 kHz SCS at a single tertiary medical center for the purpose of contributing further evidence to this growing body of data. The literature of high-frequency SCS published to date was also reviewed. MethodsA retrospective chart review was performed for patients with chronic pain syndrome, including failed back surgery syndrome and sciatica alone, who underwent high-frequency SCS at 10 kHz. This data was analyzed using R software (R Foundation for Statistical Computing, Vienna, Austria) for statistical analysis. The PubMed database was searched for relevant articles using the search terms "high frequency," "10 kHz," and "spinal cord stimulation." All relevant studies conducted to date were included in this literature review. ResultsTwenty-one patients had complete follow-up data and were included in this study. Of the 21 patients, 85.7% subjectively reported post-operative pain relief while 71.4% of the total patients reported pain relief by ≥ 50%. There was a statistically significant decrease in mean VAS scores from pre-operative to 12-months post-operative (8.52 vs 4.37, p < 0.001). Additionally, 76.5% of patients subjectively reported improvements in sleep and activities of daily living. Recent studies indicate that high-frequency SCS appears to be a viable option for delivering quality pain relief in patients for chronic regional pain syndrome, failed back surgery syndrome, sciatica, and also pain in the upper cervical region of the spine. ConclusionThis article provides evidence both with the authors' own institutional data and from the currently published literature for the efficacy of using high-frequency SCS at 10 kHz as a first-line programming option for patients undergoing SCS.

10 kHz stimulation as rescue therapy for spinal cord stimulation trial failure or loss of efficacy: A retrospective study

“…Notably, our work represents the first study exploring the effect of 10 kHz stimulation as rescue therapy in patients previously treated with multiple waveforms with an inadequate pain relief: In fact, other studies investigated the possibility to use high‐frequency algorithms only to rescue ineffective traditional stimulation with an extremely variable response ranging from 46% to 81% 36 . The possible explanation of 10 kHz paradigm success in patients experiencing LoE of other waveforms can stand in the distinctive features of the high‐frequency stimulation which shares with DTM the capacity to restore the equilibrium between pro‐ and anti‐inflammatory cytokines and positively influence the activity of glial cells in addition to the above‐mentioned mechanism of action relating to the activation of inhibiting interneurons and medial pathway; furthermore, 10 kHz paradigm has been hypothesized to block depolarization signals, desynchronize neuronal signals, disrupt membrane integration, and inhibit spinal mitogen‐activated protein kinases 37,38 …”

“…36 The possible explanation of 10 kHz paradigm success in patients experiencing LoE of other waveforms can stand in the distinctive features of the high-frequency stimulation which shares with DTM the capacity to restore the equilibrium between pro-and anti-inflammatory cytokines and positively influence the activity of glial cells in addition to the above-mentioned mechanism of action relating to the activation of inhibiting interneurons and medial pathway; furthermore, 10 kHz paradigm has been hypothesized to block depolarization signals, desynchronize neuronal signals, disrupt membrane integration, and inhibit spinal mitogen-activated protein kinases. 37,38 The switch to a different stimulation paradigm is one of the proposed strategies to overcome habituation, but other strategies have been also suggested. D'Souza et al reported a significant improvement of pain relief after a temporary interruption of stimulation, a phenomenon called holiday rescue analgesia.…”

sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE): a prospective multicentre RCT

“…5 Recently, new techniques in neuromodulation are applied successfully for the treatment of PSPS2 with predominant back pain. [6][7][8][9] Especially higher frequency spinal cord stimulation (SCS) was reported to be effective for both leg and back pain compared with conventional SCS paradigms. 7 10 More than 60% of patients experienced an ODI improvement of ≥10 points after 1 year.…”

Spinal Cord Stimulation for Painful Diabetic Neuropathy

“…According to Xu and colleagues, for patients with refractory PDN in the lower extremities, “SCS should be considered to reduce pain and improve quality of life.” 84 D’Souza and colleagues stated that SCS should be offered to patients who have refractory PDN and fail to benefit from conservative options, such as optimization of glucose control and neuropathic analgesic medications, before strong opioids are prescribed. 2 Meanwhile, current evidence favors a shift away from traditional SCS and toward paresthesia-free HF SCS 99 as first-line neuromodulation treatment 72,100 based on an accumulation of evidence showing better outcomes for HF SCS compared with traditional SCS 101-103 for many types of pain, including PDN.…”