Spinal Cord Stimulation for Pain Management: Beyond Tonic

Abstract

With over 1 billion chronic pain patients worldwide, there is an imperative need for effective solutions to manage pain. Electrical spinal cord stimulators were invented as a novel way of treating pain using the theoretical foundations of Gate Control Theory. When first developed in 1967, electrical spinal cord stimulators apply tonic electrical pulses of 40-60Hz on the spinal cord, but today a need for more efficient, paresthesia-free stimulators is eminent. This paper examines recent advancements in two alternatives to 40- 60Hz tonic waveforms: High Frequency (HF) and Burst. Both protocols showed promising results on chronic pain patients with failed surgeries before, where tonic stimulation is mainly used. They also offered optimal relief to groups where tonic stimulation is less effective: HF showed positive impacts on diabetic neuropathway patients and patients with upper body chronic pain, areas where paresthesia from tonic stimulations can cause problems. Burst showed positive influences on patients’ psychological and motivational wellbeing, which can also increase the possibility of successful pain relief.