A Systematic Evaluation of Burst Spinal Cord Stimulation for Chronic Back and Limb Pain

Burst SCS Microdosing Is as Efficacious as Standard Burst SCS in Treating Chronic Back and Leg Pain: Results From a Randomized Controlled Trial

“…In multiple comparative studies, patients report incremental improvements in pain relief with burst stimulation as compared to conventional tonic SCS, and more patients express a preference for burst stimulation Further, burst SCS results in a long‐term effect for about two out of three patients who were not sufficiently helped by tonic SCS . A 2016 systematic review highlighted the current lack of robustly designed clinical studies . Preclinical models, however, do support these initial, positive findings.…”

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

“…Despite its recent introduction, burst stimulation has been rapidly adopted by the neuromodulation community, particularly as it has become clear that most patients prefer paresthesia‐free stimulation . Multiple studies, although limited by small size and short duration, have consistently shown that burst stimulation suppresses neuropathic pain as well as or better than conventional SCS, and that most patients choose it over paresthesia stimulation . These early proof‐of‐concept studies are challenging to interpret because they generally consisted of patients with FBSS already receiving conventional SCS, and the duration of stimulation was brief, only 1 to 2 weeks .…”

Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice

“…For tonic SCS, pulse width is usually 300-500 µs, amplitude is 2-5 mA, and frequency is 30-100 Hz. 5,21 Axial back pain, and groin and foot pain are areas that are more difficult to target with tonic SCS. 22 Tonic SCS produces paraesthesia to surround and replace the area of pain.…”

“…Within each 'burst' , five pulses with a 1-ms pulse width and 1-ms spike interval are delivered at a high frequency of 500 Hz. 21 Amplitude is reduced with the aim of providing paraesthesia-free stimulation.…”

“…23 A systematic review, however, concluded that there was insufficient evidence to support or discourage use of burst SCS for chronic back and limb pain. 21 Full results of the SUNBURST (Success Using Neuromodulation with BURST) study, a multicentre randomised controlled trial comparing burst SCS with traditional tonic SCS in 121 patients, are awaited. The preliminary results involving 85 patients followed up at 24 weeks show statistically better analgesia with burst stimulation (mean difference of 6 mm visual analogue scale points), although the clinical significance appears to be small.…”