Burst Spinal Cord Stimulation in the Management of Chronic Pain: Current Perspectives

Abstract

: Over the last several decades, opioid diversion, misuse, and over-prescription have run rampant in the United States. Spinal cord stimulation (SCS) has been FDA approved for treatment for a primary indication of neuropathic limb pain that is resistant to more conservative medical therapy. The disorders qualified for treatment include neuropathic, post-surgical, post-amputation, osteodegenerative, and pain related to vascular disease. Some of the most frequently cited conditions for treatment of SCS include failed back surgery syndrome, complex regional pain syndrome (CRPS) Type I and Type II, and post-herpetic neuralgias. Developments in SCS systems have led to the differentiation between the delivered electromechanical waveform patterns, including tonic, burst, and high-frequency. Burst SCS mitigates traditional paresthesia due to expedited action potential and offers improved pain relief. Burst SCS has been shown in available studies to be non-inferior to the traditional SCS, which can cause pain paresthesia in patients who already have chronic pain. Burst SCS does not seem to cause or need the paresthesia seen in traditional SCS, making SCS not tolerable to patients. Moreover, some studies suggest that burst SCS may decrease opioid consumption in patients with chronic pain. This can make burst SCS an extremely useful tool in the battle against chronic pain and the raging opioid epidemic. As of now, more research needs to be performed to further delineate the effectiveness and long-term safety of this device.

Spinal Cord Stimulation for Painful Diabetic Neuropathy

“…Based on existing limited outcomes data, however, we conclude that for PDN, HF 10-kHz SCS, compared with traditional SCS, offers a greater likelihood of significant pain reduction and improved quality of life by eliminating paresthesias as well as allowing for a faster implant procedure. 25,72,106 Nevertheless, more data is needed for both of these forms of FDA-approved technologies for treating PDN.…”

“…Three types of electrical waveform patterns with SCS for PDN have been reported most frequently, including traditional, HF, and burst. [23][24][25] Traditional SCS therapy provides steady delivery of electric current with a low frequency of 40 to 60 Hz, with pulse amplitudes ranging from 2 to 8 mA and typical pulse widths of 200 to 500 µs. 26 This type of current elicits paresthesias, and programming is targeted to maximize overlap of the paresthesias with painful regions.…”

Following a postoperative pain in the early and late period during surgical intervention on the cervical and lumbosacral spine

“…Образование гематом в эпидуральном или субдуральном пространстве, псевдоменингоцеле, повреждения корешка, присоединение раневой инфекции сразу после операции могут представлять для пациента наибольшую опасность. Измененная биомеханика прооперированного позвоночника после поясничной дискэктомии становится фактором, инициирующим сегментарное напряжение мышц, фасций, возникновение боли после любой механической нагрузки, которая через несколько лет у 36% пациентов имеет все признаки хронической [12,20].…”

Neuromodulation’s Role in Functional Restoration in Paraplegic and Quadriplegic Patients

“…Biomedicines 2024, 12, 720 2 of 10 Currently, spinal cord stimulation is FDA-approved for primary treatment and indication of neuropathic limb pain that is resistant to more conservative therapeutic options, which will be outlined later in this article. The disorders that fall under the category of neuropathic limb pain include traditional neuropathic pain, post-surgical, post-amputation, osteodegenerative, and pain related to vascular disease [2]. Spinal cord injury patients would fall under FDA approval for spinal cord stimulation usage, as other therapeutic options provide minimal to no relief in patients, providing only a temporary solution to the lifelong pain individuals face.…”