scholarly journals Conventional and Kilohertz-frequency Spinal Cord Stimulation Produces Intensity- and Frequency-dependent Inhibition of Mechanical Hypersensitivity in a Rat Model of Neuropathic Pain

2013 ◽  
Vol 119 (2) ◽  
pp. 422-432 ◽  
Author(s):  
Ronen Shechter ◽  
Fei Yang ◽  
Qian Xu ◽  
Yong-Kwan Cheong ◽  
Shao-Qiu He ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Dynamic Range ◽  
Dorsal Column ◽  
Dependent Manner ◽  
Motor Threshold ◽  
Wide Dynamic Range ◽  
Mechanical Hypersensitivity ◽  
Dorsal Column Stimulation

Abstract Background: Spinal cord stimulation (SCS) is a useful neuromodulatory technique for treatment of certain neuropathic pain conditions. However, the optimal stimulation parameters remain unclear. Methods: In rats after L5 spinal nerve ligation, the authors compared the inhibitory effects on mechanical hypersensitivity from bipolar SCS of different intensities (20, 40, and 80% motor threshold) and frequencies (50, 1 kHz, and 10 kHz). The authors then compared the effects of 1 and 50 Hz dorsal column stimulation at high- and low-stimulus intensities on conduction properties of afferent Aα/β-fibers and spinal wide-dynamic–range neuronal excitability. Results: Three consecutive daily SCS at different frequencies progressively inhibited mechanical hypersensitivity in an intensity-dependent manner. At 80% motor threshold, the ipsilateral paw withdrawal threshold (% preinjury) increased significantly from pre-SCS measures, beginning with the first day of SCS at the frequencies of 1 kHz (50.2 ± 5.7% from 23.9 ± 2.6%, n = 19, mean ± SEM) and 10 kHz (50.8 ± 4.4% from 27.9 ± 2.3%, n = 17), whereas it was significantly increased beginning on the second day in the 50 Hz group (38.9 ± 4.6% from 23.8 ± 2.1%, n = 17). At high intensity, both 1 and 50 Hz dorsal column stimulation reduced Aα/β-compound action potential size recorded at the sciatic nerve, but only 1 kHz stimulation was partially effective at the lower intensity. The number of actions potentials in C-fiber component of wide-dynamic–range neuronal response to windup-inducing stimulation was significantly decreased after 50 Hz (147.4 ± 23.6 from 228.1 ± 39.0, n = 13), but not 1 kHz (n = 15), dorsal column stimulation. Conclusions: Kilohertz SCS attenuated mechanical hypersensitivity in a time course and amplitude that differed from conventional 50 Hz SCS, and may involve different peripheral and spinal segmental mechanisms.

scholarly journals Management of Chronic and Neuropathic Pain with 10 kHz Spinal Cord Stimulation Technology: Summary of Findings from Preclinical and Clinical Studies

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 644
Author(s):  
Vinicius Tieppo Francio ◽  
Keith F. Polston ◽  
Micheal T. Murphy ◽  
Jonathan M. Hagedorn ◽  
Dawood Sayed
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Pulse Width ◽  
Clinical Evidence ◽  
Dynamic Range ◽  
Large Diameter ◽  
Dorsal Column ◽  
The Body

Since the inception of spinal cord stimulation (SCS) in 1967, the technology has evolved dramatically with important advancements in waveforms and frequencies. One such advancement is Nevro’s Senza® SCS System for HF10, which received Food and Drug and Administration (FDA) approval in 2015. Low-frequency SCS works by activating large-diameter Aβ fibers in the lateral discriminatory pathway (pain location, intensity, quality) at the dorsal column (DC), creating paresthesia-based stimulation at lower-frequencies (30–120 Hz), high-amplitude (3.5–8.5 mA), and longer-duration/pulse-width (100–500 μs). In contrast, high-frequency 10 kHz SCS works with a proposed different mechanism of action that is paresthesia-free with programming at a frequency of 10,000 Hz, low amplitude (1–5 mA), and short-duration/pulse-width (30 μS). This stimulation pattern selectively activates inhibitory interneurons in the dorsal horn (DH) at low stimulation intensities, which do not activate the dorsal column fibers. This ostensibly leads to suppression of hyperexcitable wide dynamic range neurons (WDR), which are sensitized and hyperactive in chronic pain states. It has also been reported to act on the medial pathway (drives attention and pain perception), in addition to the lateral pathways. Other theories include a reversible depolarization blockade, desynchronization of neural signals, membrane integration, glial–neuronal interaction, and induced temporal summation. The body of clinical evidence regarding 10 kHz SCS treatment for chronic back pain and neuropathic pain continues to grow. There is high-quality evidence supporting its use in patients with persistent back and radicular pain, particularly after spinal surgery. High-frequency 10 kHz SCS studies have demonstrated robust statistically and clinically significant superiority in pain control, compared to paresthesia-based SCS, supported by level I clinical evidence. Yet, as the field continues to grow with the technological advancements of multiple waveforms and programming stimulation algorithms, we encourage further research to focus on the ability to modulate pain with precision and efficacy, as the field of neuromodulation continues to adapt to the modern healthcare era.

Modeling effects of spinal cord stimulation on wide-dynamic range dorsal horn neurons: influence of stimulation frequency and GABAergic inhibition

2014 ◽  
Vol 112 (3) ◽  
pp. 552-567 ◽  
Author(s):  
Tianhe C. Zhang ◽  
John J. Janik ◽  
Warren M. Grill
Keyword(s):  
Spinal Cord ◽  
Receptive Field ◽  
Dorsal Horn ◽  
Network Model ◽  
Spinal Cord Stimulation ◽  
Dynamic Range ◽  
Reversal Potential ◽  
Projection Neuron ◽  
Maximal Effect ◽  
Wide Dynamic Range

Spinal cord stimulation (SCS) is a clinical therapy for chronic, neuropathic pain, but an incomplete understanding of the mechanisms underlying SCS contributes to the lack of improvement in SCS efficacy over time. To study the mechanisms underlying SCS, we constructed a biophysically based network model of the dorsal horn circuit consisting of interconnected dorsal horn interneurons and a wide-dynamic range (WDR) projection neuron and representations of both local and surround receptive field inhibition. We validated the network model by reproducing cellular and network responses relevant to pain processing including wind-up, A fiber-mediated inhibition, and surround receptive field inhibition. We then simulated the effects of SCS on the activity of the WDR projection neuron and found that the response of the model WDR neuron to SCS depends on the SCS frequency; SCS frequencies of 30–100 Hz maximally inhibited the model WDR neuron, while frequencies under 30 Hz and over 100 Hz excited the model WDR neuron. We also studied the impacts on the effects of SCS of loss of inhibition due to the loss of either GABA or KCC2 function. Reducing the influence of local and surround GABAergic interneurons by weakening their inputs or their connections to the WDR neuron and shifting the anionic reversal potential of the WDR neurons upward each reduced the range of optimal SCS frequencies and changed the frequency at which SCS had a maximal effect. The results of this study provide insights into the mechanisms of SCS and pave the way for improved SCS parameter selection.

scholarly journals Comparison of FDA-Approved Electrical Neuromodulation Techniques for Focal Neuropathic Pain: A Narrative Review of DRG, HF10, and Burst Neuromodulation

2021 ◽  
pp. E407-E423
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Dorsal Root ◽  
Case Reports ◽  
Case Series ◽  
Dorsal Column ◽  
Small Sample

BACKGROUND: Evidence suggests that dorsal root ganglion stimulation (DRGS) is a more effective treatment for focal neuropathic pain (FNP) compared with tonic, paresthesia-based dorsal column spinal cord stimulation (SCS). However, new advancements in waveforms for dorsal column SCS have not been thoroughly studied or compared with DRGS for the treatment of FNP. OBJECTIVES: The purpose of this review was to examine the evidence for these novel technologies; to highlight the lack of high-quality evidence for the use of neuromodulation to treat FNP syndromes other than complex regional pain syndrome I or II of the lower extremity; to emphasize the absence of comparison studies between DRGS, burst SCS, and high-frequency SCS; and to underscore that consideration of all neuromodulation systems is more patient-centric than a one-size-fits-all approach. STUDY DESIGN: This is a review article summarizing case reports, case series, retrospective studies, prospective studies, and review articles. SETTING: The University of Miami, Florida. METHODS: A literature search was conducted from February to March 2020 using the PubMed and EMBASE databases and keywords related to DRGS, burst SCS, HF10 (high-frequency of 10 kHz), and FNP syndromes. All English-based literature from 2010 reporting clinical data in human patients were included. RESULTS: Data for the treatment of FNP using burst SCS and HF10 SCS are limited (n = 11 for burst SCS and n = 11 for HF10 SCS). The majority of these studies were small, single-center, nonrandomized, noncontrolled, retrospective case series and case reports with short follow-up duration. To date, there are only 2 randomized controlled trials for burst and HF10 for the treatment of FNP. LIMITATIONS: No studies were available comparing DRGS to HF10 or burst for the treatment of FNP. Data for the treatment of FNP using HF10 and burst stimulation were limited to a small sample size reported in mostly case reports and case series. CONCLUSIONS: FNP is a complex disease, and familiarity with all available systems allows the greatest chance of success. KEY WORDS: Dorsal root ganglion, high frequency, burst, spinal cord stimulation, neuromodulation, focal neuropathic pain

scholarly journals Considerations for the Use of Dorsal Column Stimulation for Lumbosacral Radiation Neuritis of the Nerve Root in the Spine Tumor Patient (A Case Series)

2017 ◽  
pp. 195-204
Author(s):  
Amitabh Gulati
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Dorsal Column ◽  
Spine Tumor ◽  
Tumor Patient ◽  
Post Procedure ◽  
Radiation Induced ◽  
Mri Conditional ◽  
Dorsal Column Stimulation

Background: Radiation therapy (RT) has become a mainstay in the treatment of various malignancies. Unfortunately, a potential side effect of this modality is radiation-induced neuritis. The time-course is varied and the emergence of pain syndromes can be delayed by several years after the completion of treatment. Risk factors include the total radiation dose, fractionation schedule, and radiation field size. Spinal cord stimulation (SCS) may have an important role in attenuating the symptoms of radiation-induced neuritis. Objectives: We aim to characterize a case series of oncologic patients who underwent SCS to treat iatrogenic radiation neuritis of the lumbosacral nerve roots. Study Design: This is a retrospective review of 4 cases of patients who were eligible for either intrathecal drug delivery or SCS (magnetic resonance imaging [MRI] conditional devices for spine surveillance), of which each patient elected to have a SCS trial and possible permanent implantation. Setting: The data were collected at a major cancer center in the US. Methods: In this case series, we present 4 patients with radiation-induced neuropathy. For each patient, we describe the use of SCS, which uses electric impulse generation, in an effort to treat the patient’s symptoms. To assess for efficacy, we compare pre- and post-procedure numerical rating scale (NRS) pain scores and post-procedure pain medication requirements. Results: Each patient had marked improvement in their pain (> 50%) during the trial lead placement and proceeded to the permanent implant. In subsequent months and years, the patients decreased their opioid utilization and reported an improvement in their overall pain. Limitations: This case series is a small sample size of heterogeneous malignancies with radiation treatment to the spine. Conclusions: Radiation-induced neuritis remains a severe and limiting outcome that some patients must live with after RT. Survivors of malignancy have often found this pathology to severely impact their quality of life, and it is difficult to treat. We have described the utilization of spinal cord neuromodulation as an effective treatment modality in the spine tumor patient population. Further research is needed to maximize the benefit and ensure appropriate case selection in the future. Key words: Radiation neuritis, radiation neuropathy, oncologic lumbar radiculopathy, spinal cord stimulation, neuromodulation, dorsal column stimulation, spinal tumor pain, MRI conditional spinal cord stimulation

scholarly journals Spinal Cord Stimulation Attenuates Mechanical Allodynia and Increases Central Resolvin D1 Levels in Rats With Spared Nerve Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Xueshu Tao ◽  
Xin Luo ◽  
Tianhe Zhang ◽  
Brad Hershey ◽  
Rosana Esteller ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Nerve Injury ◽  
Spinal Cord Stimulation ◽  
Mechanical Allodynia ◽  
Male Rat ◽  
Dependent Manner ◽  
Spared Nerve Injury ◽  
Resolvin D1 ◽  
Cold Allodynia

Mounting evidence from animal models of inflammatory and neuropathic pain suggests that inflammation regulates the resolution of pain by producing specialized pro-resolving mediators (SPMs), such as resolvin D1 (RvD1). However, it remains unclear how SPMs are induced in the central nervous system and whether these mechanisms can be reconciled with outcomes of neuromodulation therapies for pain, such as spinal cord stimulation. Here, we show that in a male rat model of neuropathic pain produced by spared nerve injury (SNI), 1 kHz spinal cord stimulation (1 kHz SCS) alone was sufficient to reduce mechanical allodynia and increase RvD1 in the cerebrospinal fluid (CSF). SNI resulted in robust and persistent mechanical allodynia and cold allodynia. Spinal cord electrode implantation was conducted at the T11-T13 vertebral level 1 week after SNI. The spinal locations of the implanted electrodes were validated by X-Ray radiography. 1 kHz SCS was applied for 6 h at 0.1 ms pulse-width, and this stimulation alone was sufficient to effectively reduce nerve injury-induced mechanical allodynia during stimulation without affecting SNI-induced cold allodynia. SCS alone significantly reduced interleukin-1β levels in both serum and CSF samples. Strikingly, SCS significantly increased RvD1 levels in the CSF but not serum. Finally, intrathecal injection of RvD1 (100 and 500 ng, i.t.) 4 weeks after nerve injury reduced SNI-induced mechanical allodynia in a dose-dependent manner. Our findings suggest that 1 kHz SCS may alleviate neuropathic pain via reduction of IL-1β and via production and/or release of RvD1 to control SNI-induced neuroinflammation.

Spinal cord stimulation inhibits long-term potentiation of spinal wide dynamic range neurons

2003 ◽  
Vol 973 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Johan Wallin ◽  
Atle Fiskå ◽  
Arne Tjølsen ◽  
Bengt Linderoth ◽  
Kjell Hole
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Dynamic Range ◽  
Long Term Potentiation ◽  
Wide Dynamic Range ◽  
Term Potentiation ◽  
Wide Dynamic Range Neurons

scholarly journals The use of high-dose cervical spinal cord stimulation in the treatment of chronic upper extremity and neck pain

2019 ◽  
Vol 10 ◽  
pp. 109
Author(s):  
Trey A. Baird ◽  
Chris S. Karas
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Dorsal Column ◽  
High Dose ◽  
Before And After ◽  
Stage Process ◽  
Dorsal Column Stimulation

Background: Dorsal column spinal cord stimulation is used for the treatment of chronic neuropathic pain of the axial spine and extremities. Recently, high-dose (HD) thoracic dorsal column stimulation for paresthesias has been successful. This study evaluates the utility of HD stimulation in the cervical spine for managing upper neck and upper extremity pain and paresthesias. Methods: Three patients suffering from cervical and upper extremity chronic pain were assessed. Each underwent a two-stage process that included a trial period, followed by permanent stimulator implantation. Therapy included the latest HD stimulation settings including a pulse width of 90 μs, a frequency setting of 1000 Hz, and an amplitude range of 1.5 amps–2.0 amps. Pain relief was measured utilizing relative percent pain improvement as self-reported by each patient before and after surgery. Results: After permanent implantation, (range 15–21 months), all three patients continued to experience persistent pain and paresthesia relief (70%–90%). Conclusions: In three patients, HD cervical spinal cord stimulation successfully controlled upper extremity chronic pain/paresthesias.

Pain reduction in amputees by long-term spinal cord stimulation

1980 ◽  
Vol 52 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Jörg-Ulrich Krainick ◽  
Uwe Thoden ◽  
Traugott Riechert
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Reduction ◽  
Dorsal Column ◽  
Content Type ◽  
Follow Up Study ◽  
Dorsal Column Stimulation ◽  
Fine Print

✓ This follow-up study analyzes the results of dorsal column stimulation instituted between 1972 and 1974 for the relief of pain in 84 patients, including 64 amputees. Good results decreased from 52.4% after 2 years of stimulation to 39% after 5 years. Special therapeutic problems in amputees are discussed.

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