![]() If the paresthesia intensity goes beyond tolerance, for example when postural movement or lead migration occurs 10, patients can choose to reduce the stimulation amplitude to levels that may become sub-therapeutic. With conventional SCS, patients experience a paresthesia sensation produced by stimulation with parameter settings above perception threshold 9. These parameters remain constant during stimulation for conventional SCS, forming tonic pulse (TP) trains. Major parameters defining these pulses include current intensity (amplitude), frequency (rate), and pulse width. In conventional SCS, continuous electrical pulses are delivered with fixed parameter settings through an epidural electrode array (lead) chronically implanted over the dorsal columns and connected to a battery (pulse generator). However, the mechanism of action of SCS is far more complicated and incompletely understood 8. The physiological rationale for SCS is based on the gate control theory 7, whereby activation of large myelinated afferents inhibits nociceptive transmission in the dorsal horn. Despite these advances, enhancing the efficacy of SCS while improving patient experiences remains critical for ameliorating clinical outcomes and reducing the dependence on opioids for pain management. In the past decade, advances in SCS therapy have improved the responder rate (percent of patients that exhibit at least 50% pain reduction) from 50% 3, 4 up to 73–76% at 24 months follow up 5, 6. Electrical spinal cord stimulation (SCS) is a form of neuromodulation therapy that is FDA-approved for treating mixed types of chronic and neuropathic pain conditions 2. Neuromodulation therapies offer treatment options for several neurological conditions. Neuromodulation is defined as the alteration of nerve activity at specific neurological sites in the body through targeted delivery of a stimulus 1. These results suggest that TDP modulation may improve clinical outcomes by reducing pain intensity and possibly improving the sensory experience. The anti-nociceptive effects of sinusoidal rate modulation on EEG outlasted SCS duration on the behavioral and EEG levels. Results demonstrated that under the parameter settings tested in this study, all tested patterns except pulse width modulation, significantly reversed mechanical hypersensitivity, with stochastic rate modulation achieving the highest efficacy, followed by the sinusoidal rate modulation. We tested the effects of the following SCS patterns on paw withdrawal threshold and resting state EEG theta power as a biomarker of spontaneous pain: Tonic (conventional), amplitude modulation, pulse width modulation, sinusoidal rate modulation, and stochastic rate modulation. We tested the hypothesis that modulated SCS using novel time-dynamic pulses (TDPs) leads to improved analgesia and compared the effects of SCS using conventional TPs and a collection of TDPs in a rat model of neuropathic pain according to a longitudinal, double-blind, and crossover design. Present SCS therapies are characterized by the delivery of constant stimulation in the form of trains of tonic pulses (TPs). ![]() Enhancing the efficacy of spinal cord stimulation (SCS) is needed to alleviate the burden of chronic pain and dependence on opioids.
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