Burst Spinal Cord Stimulation Evaluated in Patients With Failed Back Surgery Syndrome and Painful Diabetic Neuropathy

Vos, Cecile C de; Bom, Marjanne J.; Vanneste, Sven; Lenders, Mathieu W.P.M.; Ridder, Dirk De

doi:10.1111/ner.12116

Cited by 175 publications

(131 citation statements)

References 17 publications

(19 reference statements)

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“…Burst SCS is one such mode that uses periodic bursts of electrical pulses for pain management rather than the continuous pulses used in tonic SCS [3], [6], [8], [9]. In 2010, De Ridder et al [3] reported that burst SCS may suppress neuropathic pain as well or potentially even better than tonic SCS, possibly because burst stimulation delivers more charge per second than tonic SCS to activate different neuronal populations while remaining below the threshold for paresthesia.…”

Section: Introductionmentioning

confidence: 99%

Burst and Tonic Spinal Cord Stimulation Differentially Activate GABAergic Mechanisms to Attenuate Pain in a Rat Model of Cervical Radiculopathy

Crosby

Weisshaar

Smith

et al. 2015

IEEE Trans. Biomed. Eng.

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Section: Introductionmentioning

confidence: 99%

Burst and Tonic Spinal Cord Stimulation Differentially Activate GABAergic Mechanisms to Attenuate Pain in a Rat Model of Cervical Radiculopathy

Crosby

Weisshaar

Smith

et al. 2015

IEEE Trans. Biomed. Eng.

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“…de Vos and colleagues reported the use of burst stimulation in 48 subjects who had six months of experience with tonic stimulation 11. VAS scores were reduced by 37% from baseline using tonic stimulation.…”

Section: Introductionmentioning

confidence: 99%

Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study

Courtney¹,

Espinet²,

Mitchell

et al. 2015

Neuromodulation: Technology at the Neural Interface

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ObjectivesConventional spinal cord stimulation (SCS) delivers a tonic waveform with consistent stream of pulses; burst delivers groups of pulses separated by short pulse‐free periods. The current study compared the short‐term safety and efficacy of burst with tonic stimulation in subjects already receiving SCS.Materials and MethodsAt 4 IRB‐approved sites, 22 subjects previously implanted with an SCS device for intractable, chronic pain gave informed consent and received burst stimulation for 14 days. Subjects reported average daily Visual Analog Scale (VAS) for overall, trunk, and limb pain using tonic stimulation and after 7 and 14 days of burst stimulation. Thoughts about pain were assessed using the Pain Catastrophizing Scale. Areas of paresthesia were assessed during tonic and burst stimulation using body maps. Assessment of patient satisfaction and preferred stimulation occurred after 14 days of burst.ResultsAverage daily overall VAS reduced 46% from a mean of 53.5 (±20.2) mm during tonic SCS to 28.5 (±18.1) mm during burst (p < 0.001); trunk and limb VAS scores were also reduced by 33% and 51%, respectively. During burst, 16 subjects (73%) reported no paresthesia, 5 (23%) reported a reduction, and 1 (4%) reported increased paresthesia. After 14 days, 21 subjects (95%) reported being very satisfied or satisfied with burst. Burst was preferred by 20 subjects (91%), tonic by 1 (5%), and 1 (5%) reported no preference. Better pain relief was the most common reason cited for preference.ConclusionsA majority of subjects reported improved pain relief using burst compared with tonic stimulation. Most subjects experienced less paresthesia during burst and preferred burst citing better pain relief.

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“…motivational/affective/emotional component of the pain in contrast to traditional tonic waveforms [16]. The fact that both new stimulation designs can suppress pain better than classical tonic stimulation [14][15][16][17][18][22][23][24][25] opens up an avenue for even more new stimulation designs to be developed. Changing IPGs for trying to improve patient outcomes will lead to more surgery, with surgical and infectious risks and a financial heavy burden on society.…”

Section: Is There a Problem?mentioning

confidence: 99%

Visions on the future of medical devices in spinal cord stimulation: what medical device is needed?

Ridder

Vanneste

2016

Expert Review of Medical Devices

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Recently burst stimulation and 10 kHz stimulation have been developed as novel stimulation designs. Both appear to be superior to classical tonic stimulation in the amount of responders and the amount of pain suppression and have as an extra advantage that they are paresthesia-free. This evolution is very important as it shifts the focus of research from better targeting by developing new lead configurations to better communication with the nervous system. It can be envisioned that this is only the start of a new trend in spinal cord, brain, and peripheral nerve stimulation and that more new stimulation designs will be developed in the near future such as pseudorandom burst stimulation, pleasure stimulation, noise stimulation and reconditioning stimulation. This evolution mandates a new approach in the development of internal pulse generators, and the most obvious approach is to develop an upgradable stimulator, on which new stimulation designs can be downloaded, analogous to the apps people download on their smartphones. This will create a shift from hardware driven products to software driven stimulators.

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Burst Spinal Cord Stimulation Evaluated in Patients With Failed Back Surgery Syndrome and Painful Diabetic Neuropathy

Cited by 175 publications

References 17 publications

Burst and Tonic Spinal Cord Stimulation Differentially Activate GABAergic Mechanisms to Attenuate Pain in a Rat Model of Cervical Radiculopathy

Burst and Tonic Spinal Cord Stimulation Differentially Activate GABAergic Mechanisms to Attenuate Pain in a Rat Model of Cervical Radiculopathy

Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study

Visions on the future of medical devices in spinal cord stimulation: what medical device is needed?

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