Preferred frequencies and waveforms for spinal cord stimulation in patients with complex regional pain syndrome: A multicentre, double‐blind, randomized and placebo‐controlled crossover trial

Kriek, Nadia; Groeneweg, George; Stronks, Dirk L.; Ridder, Dirk De; Huygen, Frank

doi:10.1002/ejp.944

Cited by 103 publications

(120 citation statements)

References 41 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…These results replicated findings of previous smaller studies, although the observed difference in pain scores was somewhat less than what others reported . It may be that burst stimulation works best in certain clinical scenarios, as shown in a recent crossover study of patients with CRPS that compared standard (conventional 40 Hz), nonstandard (500 Hz, 1,200 Hz, and burst), and placebo stimulation for 2 weeks . The investigators found that most patients preferred standard SCS, and that pain relief was comparable for standard and nonstandard settings.…”

Section: Burst Stimulationsupporting

confidence: 83%

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

2018

View full text Add to dashboard Cite

Spinal cord stimulation (SCS) is a minimally invasive therapy used for the treatment of chronic neuropathic pain. SCS is a safe and effective alternative to medications such as opioids, and multiple randomized controlled studies have demonstrated efficacy for difficult-to-treat neuropathic conditions such as failed back surgery syndrome. Conventional SCS is believed mediate pain relief via activation of dorsal column Aβ fibers, resulting in variable effects on sensory and pain thresholds, and measurable alterations in higher order cortical processing. Although potentiation of inhibition, as suggested by Wall and Melzack's gate control theory, continues to be the leading explanatory model, other segmental and supraspinal mechanisms have been described. Novel, non-standard, stimulation waveforms such as high-frequency and burst have been shown in some studies to be clinically superior to conventional SCS, however their mechanisms of action remain to be determined. Additional studies are needed, both mechanistic and clinical, to better understand optimal stimulation strategies for different neuropathic conditions, improve patient selection and optimize efficacy.

show abstract

Section: Burst Stimulationsupporting

confidence: 83%

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

2018

View full text Add to dashboard Cite

show abstract

“…Consistent with the results of the PROCO RCT, other RCTs have indicated that 1 kHz stimulation is effective 16, 17. Kriek et al compared 40, 500, 1200 Hz, burst, and placebo SCS, finding that the four stimulation programs were equally effective and they were all significantly more effective than placebo.…”

Section: Discussionmentioning

confidence: 60%

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

137

130

View full text Add to dashboard Cite

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.

show abstract

“…In the field of Burst stimulation, contradictory findings regarding the superiority of Burst‐SCS over Con‐SCS have been reported. While some studies show a clear advantage of Burst‐SCS over Con‐SCS , other studies show no difference between the two stimulation modalities in terms of their pain relieving effect , which may have resulted from the different disease indications assessed in these studies. The superiority of Burst‐SCS observed in some studies might be attributed to the mechanism of action of Burst‐SCS, as it is hypothesized that Burst‐SCS, besides targeting brain areas related to the location and intensity of pain (lateral pain pathway), also target areas related to the emotional and affective components of pain (medial pain pathway) .…”

Section: Discussionmentioning

confidence: 79%

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

View full text Add to dashboard Cite

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.

show abstract

Preferred frequencies and waveforms for spinal cord stimulation in patients with complex regional pain syndrome: A multicentre, double‐blind, randomized and placebo‐controlled crossover trial

Cited by 103 publications

References 41 publications

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

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

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

Contact Info

Product

Resources

About