Conventional-SCS vs. Burst-SCS and the Behavioral Effect on Mechanical Hypersensitivity in a Rat Model of Chronic Neuropathic Pain: Effect of Amplitude

Meuwissen, Koen P.V.; Gu, Jianwen Wendy; Zhang, Tianhe C.; Joosten, Elbert A.J.

doi:10.1111/ner.12731

Cited by 31 publications

(54 citation statements)

References 45 publications

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“…Nor does the data support the idea that decreasing frequency while holding pulse width and amplitude constant would be effective, because the amount of charge required by 10 kHz is three times greater than 1 kHz, not ten times greater as would be expected if changing only frequency were effective. The finding that titration is important is consistent with recent observations that titration of amplitude improves burst SCS outcomes 29, 30 and with findings in preclinical models 31.…”

Section: Discussionsupporting

confidence: 91%

Effects of Rate on Analgesia in Kilohertz Frequency Spinal Cord Stimulation: Results of the PROCO Randomized Controlled Trial

Thomson

Tavakkolizadeh

Love‐Jones

et al. 2018

Neuromodulation: Technology at the Neural Interface

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ObjectiveThe PROCO RCT is a multicenter, double‐blind, crossover, randomized controlled trial (RCT) that investigated the effects of rate on analgesia in kilohertz frequency (1–10 kHz) spinal cord stimulation (SCS).Materials and MethodsPatients were implanted with SCS systems and underwent an eight‐week search to identify the best location (“sweet spot”) of stimulation at 10 kHz within the searched region (T8–T11). An electronic diary (e‐diary) prompted patients for pain scores three times per day. Patients who responded to 10 kHz per e‐diary numeric rating scale (ED‐NRS) pain scores proceeded to double‐blind rate randomization. Patients received 1, 4, 7, and 10 kHz SCS at the same sweet spot found for 10 kHz in randomized order (four weeks at each frequency). For each frequency, pulse width and amplitude were titrated to optimize therapy.ResultsAll frequencies provided equivalent pain relief as measured by ED‐NRS (p ≤ 0.002). However, mean charge per second differed across frequencies, with 1 kHz SCS requiring 60–70% less charge than higher frequencies (p ≤ 0.0002).ConclusionsThe PROCO RCT provides Level I evidence for equivalent pain relief from 1 to 10 kHz with appropriate titration of pulse width and amplitude. 1 kHz required significantly less charge than higher frequencies.

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Section: Discussionsupporting

confidence: 91%

Effects of Rate on Analgesia in Kilohertz Frequency Spinal Cord Stimulation: Results of the PROCO Randomized Controlled Trial

Thomson

Tavakkolizadeh

Love‐Jones

et al. 2018

Neuromodulation: Technology at the Neural Interface

Self Cite

140

130

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“…The gradual decrease in therapy efficacy with stimulation amplitudes beyond this optimum might be explained by the fact that sensory, potential uncomfortable, sensations induced by the stimulation might have taken place. Interestingly, a recent study by Meuwissen et al showed that Burst‐SCS also followed this nonlinear course between amplitude and behavioral outcome . The optimal amplitude for Burst‐SCS in that study was reported to be 50% MT, and the behavioral outcome was shown to decline rather rapidly when this optimal amplitude was surpassed .…”

Section: Discussionsupporting

confidence: 83%

“…In contrast, the Burst‐DRGS paradigm as used in the present study demonstrated a larger optimal therapeutic window (50%–66% MT). Differences in terms of this optimal therapeutic window between our study and the study of Meuwissen and colleagues might be attributed to the experimental model used (PDPN vs. Seltzer lesion), the location of stimulation (spinal cord vs. DRG), the type of stimulation used (quadripolar vs. bipolar), and/or the Burst waveform used (biphasic with active recharge balance vs. monophasic with passive recharge balance) . Additionally, a study by Tang et al found that while spinal neuronal responses to colorectal distension and pinch were reduced similarly using tonic SCS and Burst‐SCS at 90% MT, Burst, but not tonic SCS significantly decreased the nociceptive somatic response after colorectal distension or pinch using lower amplitudes of 60% MT .…”

Section: Discussioncontrasting

confidence: 59%

Nonlinear Relation Between Burst Dorsal Root Ganglion Stimulation Amplitude and Behavioral Outcome in an Experimental Model of Painful Diabetic Peripheral Neuropathy

Franken

Debets

Joosten

2020

Neuromodulation: Technology at the Neural Interface

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Background and objective Dorsal root ganglion stimulation (DRGS) has recently emerged as a neuromodulation modality in the treatment of chronic neuropathic pain. The objective of this study was to compare the efficacy of different Burst‐DRGS amplitudes in an experimental model of painful diabetic peripheral neuropathy (PDPN). Methods Diabetes mellitus was induced in female Sprague–Dawley rats by intraperitoneal injection of streptozotocin (STZ, n = 28). Animals were tested for mechanical hypersensitivity (von Frey paw withdrawal test) before, and four weeks after STZ injection. PDPN rats (n = 13) were implanted with a unilateral bipolar electrode at the L5 DRG. Animals received Burst‐DRGS at 0%, 10%, 33%, 50%, 66%, and 80% of motor threshold (MT) in a randomized crossover design on post‐implantation days 2–7 (n = 9). Mechanical hypersensitivity was assessed before stimulation onset, 15 and 30 min during stimulation, and 15 and 30 min after stimulation. Results Burst‐DRGS at amplitudes of 33%, 50%, 66%, and 80% MT resulted in significant attenuation of STZ‐induced mechanical hypersensitivity at 15 and 30 min during stimulation, as well as 15 min after cessation of stimulation. No effect on mechanical hypersensitivity was observed for Burst‐DRGS at 0% MT and 10% MT. Optimal pain relief and highest responder rates were achieved with Burst‐DRGS at 50–66% MT, with an estimated optimum at 52% MT. Conclusion Our findings indicate a nonlinear relationship between Burst‐DRGS amplitude and behavioral outcome, with an estimated optimal amplitude of 52% MT. Further optimization and analysis of DRGS driven by insights into the underlying mechanisms related to the various stimulation paradigms is warranted.

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“…The motor thresholds necessary to evoke contractions of the hind paws of the animals were lower for Burst‐DRGS than Con‐DRGS in our study, albeit not significant. This is in line with preclinical findings that Burst‐SCS requires significantly lower amplitudes to obtain a motor response when compared to Con‐SCS . The latter has important consequences for the stimulation amplitude, which is generally lower with Burst‐SCS when compared to Con‐SCS .…”

Section: Discussionmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation in Experimental Painful Diabetic Peripheral Neuropathy: Burst vs. Conventional Stimulation Paradigm

Franken

Debets

Joosten

2019

Neuromodulation: Technology at the Neural Interface

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Objectives Painful diabetic peripheral neuropathy (PDPN) is a long‐term complication of diabetes mellitus (DM). Dorsal Root Ganglion Stimulation (DRGS) has recently emerged as a neuromodulation modality in the treatment of chronic neuropathic pain. The objective of this study was to compare the effect of burst DRGS (Burst‐DRGS) and conventional DRGS (Con‐DRGS) in an experimental model of PDPN. Materials and Methods DM was induced in female Sprague–Dawley rats by intraperitoneal injection of streptozotocin (STZ, n = 48). Animals were tested for mechanical hypersensitivity (50% hind paw withdrawal threshold on Von Frey test) before, and 4 weeks after STZ injection. PDPN rats were then implanted with a unilateral bipolar lead at the L5 DRG (n = 22) and were stimulated for 30 min at days 2 and 3 postimplantation. Animals received Con‐DRGS and Burst‐DRGS in a randomized crossover design (n = 10), or received Sham‐DRGS (n = 7) for 30 min, and were tested for mechanical hypersensitivity at baseline, 15 and 30 min during DRGS, and 15 and 30 min following DRGS. Five animals were withdrawn from the study due to electrode‐related technical problems. Results Con‐DRGS and Burst‐DRGS normalized STZ‐induced mechanical hypersensitivity at 15 and 30 min during stimulation. A significant difference in terms of mechanical hypersensitivity was observed between both of the stimulated groups and the Sham‐DRGS group at 15 and 30 min during stimulation. Interestingly, Burst‐DRGS showed signs of a residual effect at 15 min after cessation of stimulation, while this was not the case for Con‐DRGS. Conclusions Under the conditions tested, Con‐DRGS and Burst‐DRGS are equally effective in attenuating STZ‐induced mechanical hypersensitivity in an animal model of PDPN. Burst‐DRGS showed signs of a residual effect at 15 min after cessation of stimulation, which requires further investigation.

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Conventional-SCS vs. Burst-SCS and the Behavioral Effect on Mechanical Hypersensitivity in a Rat Model of Chronic Neuropathic Pain: Effect of Amplitude

Cited by 31 publications

References 45 publications

Effects of Rate on Analgesia in Kilohertz Frequency Spinal Cord Stimulation: Results of the PROCO Randomized Controlled Trial

Effects of Rate on Analgesia in Kilohertz Frequency Spinal Cord Stimulation: Results of the PROCO Randomized Controlled Trial

Nonlinear Relation Between Burst Dorsal Root Ganglion Stimulation Amplitude and Behavioral Outcome in an Experimental Model of Painful Diabetic Peripheral Neuropathy

Dorsal Root Ganglion Stimulation in Experimental Painful Diabetic Peripheral Neuropathy: Burst vs. Conventional Stimulation Paradigm

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