Burst and 10 kHz Spinal Cord Stimulation: Different and Common Brain Mechanisms

Area of Science:

• Neuroscience
• Pain Management
• Medical Devices

Background:

• Spinal cord stimulation (SCS) is a standard treatment for intractable pain.
• Paresthesia-free SCS options include 10 kHz high-frequency stimulation and burst stimulation.
• A shared mechanism between 10 kHz and burst SCS has been theorized but not proven.

Purpose of the Study:

• To investigate the similarities and differences between 10 kHz and burst SCS.
• To examine the neurophysiological effects of these two SCS modalities using electroencephalography (EEG).

Main Methods:

• Ten patients received both burst and 10 kHz SCS for ten days each.
• Clinical pain scores and source-localized EEG data were analyzed.
• EEG subtraction and conjunction analyses were performed to compare brain activity.

Main Results:

• Both 10 kHz and burst SCS significantly reduced leg pain similarly.
• Burst SCS showed a greater reduction in back pain compared to 10 kHz SCS.
• Both modalities activated the pregenual anterior cingulate cortex (pgACC), correlating with pain relief.
• Burst SCS additionally modulated other brain regions, including the dorsal anterior cingulate cortex, linked to back pain reduction.

Conclusions:

• Both 10 kHz and burst SCS modulate the descending pain-inhibitory system via pgACC activation.
• Burst SCS offers additional modulation of specific brain regions associated with back pain relief.
• These findings provide evidence for overlapping and distinct neural mechanisms of different SCS paradigms.