Neurophysiological Comparison Among Tonic, High Frequency, and Burst Spinal Cord Stimulation: Novel Insights Into Spinal and Brain Mechanisms of Action

Objective Measures to Characterize the Physiological Effects of Spinal Cord Stimulation in Neuropathic Pain: A Literature Review

“…A few studies ( n = 3) have also selectively examined the effects of SCS on evoked electrical potentials recorded via intracerebral electrodes in the thalamus and found similar evidence, suggesting that SCS modifies evoked responses to innocuous and painful peripheral nerve stimulation at the thalamic level . Two additional studies used transcranial magnetic stimulation to investigate the effects of SCS on cortical excitability in patients with neuropathic pain and found that SCS was able to efficiently modulate cortical excitability . In one study, SCS was shown to decrease cortical excitability in patients (with lumbosacral root injury syndrome), primarily indicated by a reduction of intracortical facilitation that was paralleled by a decrease in self‐reported pain experience .…”

“…Among the 67 studies included in this review, 24 used neurophysiological measures (27)(28)(29)(30)(31)(32)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), 14 used functional neuroimaging techniques (12,(33)(34)(35)(36)(60)(61)(62)(63)(64)(65)(66)(67)(68), 3 used a combination of neurophysiological and functional neuroimaging techniques (69-71), 14 used quantitative sensory testing (37)(38)(39)(72)(73)(74)(75)(76)(77)(78)(79)(80)…”

“…Twenty-four studies used neurophysiological measures to assess the mechanistic effects of SCS (27)(28)(29)(30)(31)(32)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59) (Table 1). Among these, 12 studies examined the effects of SCS on cortical processing by measuring changes in somatosensory evoked potentials (SSEPs) to electrical stimulation of large (Aβ) fibers.…”

“…These results suggested that thermal nociception could potentially be reduced in CRPS patients with the use of SCS (51). An additional study by Bocci et al used EEG to measure eventrelated brain potentials in response to laser-heat (laser evoked potentials, LEPs), to study the effects of SCS (59). In particular, LEPs were used to distinguish the effects of SCS frequency (lowfrequency [10-200 Hz] SCS, high-frequency [10,000 Hz] SCS, and burst [500 Hz spike mode, 40 Hz burst mode] SCS) on nociceptive transmission along spinal pathways.…”

Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level

“…This kind of LEP response is in line with a previous study that focused on tonic SCS . Conversely, a recent study has reported decreases in N2–P2 amplitudes in patients with low back pain under tonic, high frequency, and burst SCS , although no significant correlation with pain intensity was found. No study to date has assessed LEPs in patients under DRGS.…”