Novel Pulsed-Ultrahigh-Frequency Spinal Cord Stimulation Inhibits Mechanical Hypersensitivity and Brain Neuronal Activity in Rats after Nerve Injury.

Abstract

Spinal cord stimulation (SCS) is an important pain treatment modality. We hypothesized that a novel pulsed-ultrahigh-frequency SCS (pUHF-SCS) could safely and effectively inhibit spared nerve injury-induced neuropathic pain in rats. Epidural pUHF-SCS (± 3V, 2Hz pulses comprising 500 kHz biphasic sinewaves) was implanted at the thoracic vertebrae (T9-T11). Local field brain potentials following hind paw stimulation were recorded. Analgesia was evaluated by von-Frey-evoked allodynia and acetone-induced cold allodynia. The mechanical withdrawal threshold of the injured paw was 0.91 ± 0.28 g lower than that of the sham surgery (24.9 ± 1.2 g). Applying 5-, 10-, or 20-minute pUHF-SCS five times every two days significantly increased the paw withdrawal threshold to 13.3 ± 6.5, 18.5 ± 3.6, and 21.0 ± 2.8 g at 5 hours post-SCS, respectively (p = 0.0002, < 0.0001, and < 0.0001; n = 6/group), and to 6.1 ± 2.5, 8.2 ± 2.7, and 14.3 ± 5.9 g on the second day, respectively (p = 0.123, 0.013, and < 0.0001). Acetone-induced paw response numbers decreased from pre-SCS (41 ± 12) to 24 ± 12 and 28 ± 10 (p = 0.006 and 0.027; n = 9) at 1 and 5 hours post-three rounds of 20-minute pUHF-SCS, respectively. The areas under the curve from the C component of the evoked potentials at the left primary somatosensory and anterior cingulate cortices were significantly decreased from pre-SCS (101.3 ± 58.3 and 86.9 ± 25.5, respectively) to 39.7 ± 40.3 and 36.3 ± 20.7 (p = 0.021, and 0.003; n = 5) at 60 minutes post-SCS, respectively. The intensity thresholds for pUHF-SCS to induce brain and sciatic nerve activations were much higher than the therapeutic intensities and thresholds of conventional low-frequency SCS. pUHF-SCS inhibited neuropathic pain-related behavior and paw stimulation evoked brain activation through mechanisms distinct from low-frequency SCS.