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Exploration of High- and Low-Frequency Options for Subperception Spinal Cord Stimulation Using Neural Dosing
José Paz-Solís1, Simon Thomson2, Roshini Jain3
1University Hospital La Paz, Madrid, Spain.
Summary
Subperception spinal cord stimulation (SCS) can effectively relieve chronic pain using lower frequencies, significantly reducing energy consumption. This study demonstrates that frequencies as low as 10 Hz provide substantial pain relief and patient preference for lower settings.
Area of Science:
- Neuromodulation
- Pain Management
- Spinal Cord Stimulation
Background:
- Subperception spinal cord stimulation (SCS) typically uses high-energy waveforms.
- The necessity of high-energy waveforms for effective subperception has not been established.
- Exploring lower frequencies for SCS could lead to energy savings.
Purpose of the Study:
- To determine if effective subperception pain relief is achievable with frequencies below 1 kHz.
- To investigate the relationship between frequency, neural dose, and energy consumption in SCS.
- To assess patient preference for lower-frequency SCS.
Main Methods:
- A multicenter, observational study of 30 chronic pain patients with SCS implants.
- Utilized a novel electric field shape for dorsal horn modulation.
- Tested frequencies from 10 kHz down to 10 Hz, adjusting amplitude and pulse width for optimal response.
Main Results:
- All tested frequencies (10 Hz to 1 kHz) provided effective subperception pain relief (66-72% reduction).
- Lower frequencies required adjusted neural dosing but resulted in significant energy savings (up to 97% at 10 Hz vs. 1 kHz).
- Pain relief was sustained for one year, with 85% of patients preferring frequencies at or below 400 Hz.
Conclusions:
- Effective subperception SCS can be achieved at low frequencies (10-10,000 Hz).
- A specific electric field configuration and neural dosing parameters enable low-frequency SCS.
- This approach offers substantial energy savings and maintains long-term pain relief.
