Computational Analysis of Kilohertz Frequency Spinal Cord Stimulation for Chronic Pain Management

Lempka, Scott F.; McIntyre, Cameron C.; Kilgore, Kevin L.; Machado, André G.

doi:10.1097/aln.0000000000000649

Cited by 122 publications

(142 citation statements)

References 47 publications

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“…An example of this is the use of 10 kHz waveform for spinal cord stimulation [38]. Initially it was commonly thought that this waveform produced a conduction block of fibers [25,70], but subsequent studies have shown that this is unlikely to be the mechanism of action for this particular device [71,72]. …”

Section: Waveforms Often Associated With Electrical Nerve Blockmentioning

confidence: 99%

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Reversible Conduction Block in Peripheral Nerve Using Electrical Waveforms

et al. 2017

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Introduction Electrical nerve block uses electrical waveforms to block action potential propagation. Materials & Methods Two key features that distinguish electrical nerve block from other nonelectrical means of nerve block: block occurs instantly, typically within 1 s; and block is fully and rapidly reversible (within seconds). Results Approaches for achieving electrical nerve block are reviewed, including kilohertz frequency alternating current and charge-balanced polarizing current. We conclude with a discussion of the future directions of electrical nerve block. Conclusion Electrical nerve block is an emerging technique that has many significant advantages over other methods of nerve block. This field is still in its infancy, but a significant expansion in the clinical application of this technique is expected in the coming years.

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Section: Waveforms Often Associated With Electrical Nerve Blockmentioning

confidence: 99%

“…To date, there is no clear resolution to this issue. Computational simulations suggest that KHFAC block is more likely to block large fibers [3,71]. Experimental results suggest that this effect may reverse at high frequencies (i.e., >50 kHz) [24].…”

Section: Conclusion and Future Perspectivementioning

confidence: 99%

Reversible Conduction Block in Peripheral Nerve Using Electrical Waveforms

et al. 2017

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“…The emergence of kilohertz frequency (1–10 KHz ) spinal cord stimulation (kHz-SCS) 1–7 for the treatment of neuropathic pain has engendered studies on new mechanisms of actions (MoA) 5,8–11 . Divergent clinical observations for conventional rate SCS and kHZ-SCS suggest difference in MoA which could in turn inform distinct programming optimization strategies.…”

Section: Introductionmentioning

confidence: 99%

Temperature increases by kilohertz frequency spinal cord stimulation

et al. 2019

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Introduction: Kilohertz frequency spinal cord stimulation (kHz-SCS) deposits significantly more power in tissue compared to SCS at conventional frequencies, reflecting increased duty cycle (pulse compression). We hypothesize kHz-SCS increases local tissue temperature by joule heat, which may influence the clinical outcomes. Methods: To establish the role of tissue heating in KHZ-SCS, a decisive first step is to characterize the range of temperature changes expected during conventional and KHZ-SCS protocols. Fiber optic probes quantified temperature increases around an experimental SCS lead in a bath phantom. These data were used to verify a SCS lead heat-transfer model based on joule heat. Temperature increases were then predicted in a seven-compartment (soft tissue, vertebral bone, fat, intervertebral disc, meninges, spinal cord with nerve roots) geometric human spinal cord model under varied parameterization. Results: The experimentally constrained bio-heat model shows SCS waveform power (waveform RMS) determines tissue heating at the spinal cord and surrounding tissues. For example, we predict temperature increased at dorsal spinal cord of 0.18–1.72 °C during 3.5 mA peak 10 KHz stimulation with a 40–10–40 μs biphasic pulse pattern, 0.09–0.22 °C during 3.5 mA 1 KHz 100–100–100 μs stimulation, and less than 0.05 °C during 3.5 mA 50 Hz 200–100–200 μs stimulation. Notably, peak heating of the spinal cord and other tissues increases superlinearly with stimulation power and so are especially sensitive to incremental changes in SCS pulse amplitude or frequency (with associated pulse compression). Further supporting distinct SCS intervention strategies based on heating; the spatial profile of temperature changes is more uniform compared to electric fields, which suggests less sensitivity to lead position. Conclusions: Tissue heating may impact short and long-term outcomes of KHZ-SCS, and even as an adjunct mechanism, suggests distinct strategies for lead position and programming optimization.

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“…6,7 These include central mechanisms of cortical reorganization, 57-59 inhibition of neural conduction at the dorsal horn and supraspinal structures, 56,[60][61][62][63] GABAergic and endogenous opioid receptor activation, 61,64,65 attenuation of wide dynamic range neuronal excitability and decreased glial cell activation, 66,67 and sympathetic nervous system inactivation with resultant improvements in peripheral circulation. 68,69 Successful treatment with SCS is more than a dichotomous "yes" or "no" assessment for pain or the attainment of an arbitrary 50% analgesia.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

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To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

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Computational Analysis of Kilohertz Frequency Spinal Cord Stimulation for Chronic Pain Management

Cited by 122 publications

References 47 publications

Reversible Conduction Block in Peripheral Nerve Using Electrical Waveforms

Reversible Conduction Block in Peripheral Nerve Using Electrical Waveforms

Temperature increases by kilohertz frequency spinal cord stimulation

Spinal Cord Stimulation 50 Years Later

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