Novel Spinal Cord Stimulation Parameters in Patients with Predominant Back Pain

Advanced waveforms and frequency with spinal cord stimulation: burst and high-frequency energy delivery

“…spinal cord stimulation Since spinal cord stimulation (SCS) was introduced in 1967, the evolution has tried to keep pace with the demands of the chronic pain patients' needs [1,2]. Attention has now started to focus on innovative central axis targets and waveforms [3][4][5]. Theoretically, the technology was based on the gate control mechanism proposed by Melzack and Wall stating that activity in large-diameter cutaneous fibers (type Ab) inhibits the transmission of noxious information to the brain.…”

High-Frequency Stimulation: A Novel Strategy in Waveform Applications

“…Although at the time of this writing it has been formally published, it was presented at the North American Neuromodulation Society Annual meeting in December 2014. Dr. Leo Kapural presented the data from the US pivotal trial that demonstrated statistical superiority for HF10 as compared to traditional SCS to treat both back and leg pain [ 6 ]. Furthermore, it mirrors the data from Europe [ 3 , 4 ] and the investigation in the United States [ 5 ] (Table 10.1 ).…”

Spinal Stimulation for Pain: Future Applications

“…This known phenomenon necessitates intraoperative paresthesia mapping and requires interaction with patients during the electrode implantation procedure. However, once the stimulation frequency is increased, paresthesias disappear, whereas pain relief remains or even improves [10]. This phenomenon was observed when the stimulation frequency was increased to 10,000 Hz with 30-μs stimulation pulses and the current ranging from 0.5 to 5.0 mA [10].…”

“…However, once the stimulation frequency is increased, paresthesias disappear, whereas pain relief remains or even improves [10]. This phenomenon was observed when the stimulation frequency was increased to 10,000 Hz with 30-μs stimulation pulses and the current ranging from 0.5 to 5.0 mA [10]. Using this concept, 10-kHz stimulation was introduced into clinical practice several years ago, and is currently used outside of the USA (mainly in Europe and Australia).…”

“…To date, a 2-year follow-up on this cohort of patients treated with high-frequency SCS has been published [12], and the results were consistent: 60 % of patients reported >50 % reduction from baseline back pain and 71 % reported >50 % reduction in leg pain [12]. In addition to this, a smaller-scale cohort study (24 patients), in a short-term trial, investigated differences with conventional and high-frequency (10 kHz) SCS using an external stimulator connected to epidural SCS electrode leads [10]. Here, once again, high-frequency stimulation did not elicit paresthesias, but resulted in a significant reduction of both back pain and overall pain; this reduction was much more pronounced in the high-frequency trial stage than in a conventional trial.…”