Altering Conventional to High Density Spinal Cord Stimulation: An Energy Dose-Response Relationship in Neuropathic Pain Therapy

The Efficacy of High-Density Spinal Cord Stimulation Among Trial, Implant, and Conversion Patients: A Retrospective Case Series

“…However, HD programming, unlike other paresthesia‐free programming options (e.g., HF10) did not have superior pain reduction or higher responder rates (e.g., HF10, >80% for back and leg pain) . Our findings support Sweet et al and Wille et al who demonstrated that paresthesias are not necessary for pain relief and that subthreshold HD with traditional systems is a viable alternative to conventional programming in a subset of patients. However, we extend the findings of Sweet et al by demonstrating continued pain relief at a minimum of 12 months beyond the previously documented two‐week test period.…”

“…Unlike post‐laminectomy pain, complex regional pain syndrome patients did experience significant pain reduction at 12 months compared to baseline and were associated with a high responder rate of 71%. Wille et al , also suggested that patients with neuropathic pain and CRPS in comparison to patients with post‐laminectomy pain syndrome tended to have a stronger clinical effect with HD programming. Our work suggests that different patient populations may preferentially respond to HD programming.…”

“…Alternate methods of energy delivery are being considered for conventional SCS systems by adjusting conventional programming parameters to affect the total charge delivered per unit time . One high electrical charge delivery method being considered is subthreshold (paresthesia‐reduced or ‐free) HD programming . The rationale for HD SCS is to provide a higher charge delivery over a specific period.…”

Conventional and Novel Spinal Stimulation Algorithms: Hypothetical Mechanisms of Action and Comments on Outcomes

“…In another recently published report, Wille et al have presented data from 30 patients originally treated with conventional SCS but who after different time periods, on average 32 months after implant, experienced such a reduction of the therapeutic effect or unwanted side‐effects that their SCS system was reprogrammed to HD stimulation. The anatomical target with bipolar stimulation at T9–T10 was chosen and the frequencies were set to highest possible (1000 Hz in modern rechargeable stimulators) with a PW of 300–400 μsec.…”

Optimization of Medial Forebrain Bundle Stimulation Parameters for Operant Conditioning of Rats

“…More traditional, low- or high-frequency or interleaved stimulation patterns have also been used in DBS. These parameters have been applied and modified to improve clinical outcomes and achieve fewer side effects [37, 38]. Based on the findings described in the present study, it seems that greater efficacy of burst stimulation patterns is achieved when this stimulation more closely approximates the endogenous, physiological rhythms of the neuronal targets [39].…”