Abstract
Since paresthesia inducing, fixed parameter spinal cord stimulation (SCS) was first introduced in 1967 (1), both the scientific understanding and technology of SCS have advanced dramatically. Sophisticated waveforms leveraging a mechanistic understanding of the underlying molecular, cellular, and neural pathways responsible for optimal pain relief are now in broad clinical use (2). Closed-loop (CL) SCS systems that automatically control the stimulator outputs to compensate for biophysical variability were introduced, and the spinal evoked compound action potential (ECAP) is now being investigated to afford SCS dose control informed by changes in neural activation (3).
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