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Burst spinal cord stimulation for limb and back pain
Dirk De Ridder1, Mark Plazier, Niels Kamerling
1Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; BRAI(2)N, Saint Augustinus Hospital, Antwerp, Belgium.
World Neurosurgery
|January 17, 2013
Summary
Burst stimulation for neuropathic pain offers significant relief without paresthesias, unlike traditional tonic stimulation. This novel approach provides superior pain management and improves attention to pain, demonstrating its effectiveness in clinical trials.
Area of Science:
- Neuromodulation
- Pain Management
- Neuroscience
Background:
- Spinal cord stimulation (SCS) is a common treatment for intractable neuropathic pain.
- Tonic SCS often evokes paresthesias, limiting objective efficacy assessment.
- Burst SCS, a newer technique, delivers high-frequency stimuli without paresthesias.
Purpose of the Study:
- To compare the efficacy of burst SCS, tonic SCS, and placebo in treating neuropathic pain.
- To evaluate pain relief and sensory changes associated with different SCS paradigms.
- To investigate the neural mechanisms underlying burst SCS using electroencephalography (EEG).
Main Methods:
- A randomized, placebo-controlled trial involving 15 neuropathic pain patients.
- Comparison of three SCS paradigms: burst, tonic, and placebo.
- Primary outcomes: Visual Analog Scale (VAS) for back, limb, and general pain.
- Secondary outcomes: Pain Vigilance and Awareness Questionnaire (PVAQ), VAS for worst, least, and momentary pain.
- Subgroup analysis (5 patients) using source-localized EEG.
Main Results:
- Burst SCS significantly improved back, limb, and general pain (51-55%) compared to tonic SCS (30-52%) and placebo.
- Burst SCS showed superior outcomes for current, least, and worst pain (50-73%) versus tonic SCS (13-46%).
- EEG revealed greater activation of the dorsal anterior cingulate cortex and right dorsolateral prefrontal cortex with burst SCS.
Conclusions:
- Burst SCS provides superior pain relief compared to tonic SCS and placebo.
- The efficacy of burst SCS may stem from selective modulation of medial pain pathways.
- Burst SCS demonstrates a more favorable impact on pain perception and awareness than tonic SCS.
