![]() ![]() ![]() All evaluated changes in pain intensity or pain quality with burst SCS ( Table 1). In total, 20 papers were included in this review. Published papers were also graded by level of evidence utilizing standardized methods on a scale from level 1 (RCT) to 5 (Expert Opinion). Disagreement on selection of literature was resolved by consensus. All authors participated in the selection process. Īrticles were excluded on the following criteria: Indications other than pain of the trunk or limbs, nonhuman studies, published study protocols, technical reports with no outcome measurements, conference proceedings on smaller cohorts and treatments other than spinal cord stimulation. All included papers were peer reviewed, except two conference reports. Literature included both prospective and retrospective studies reporting clinical outcome measures when treating chronic pain using burst SCS, regardless of the underlying pain condition or length of treatment time. Most recently, burst SCS was shown to result in statistically superior pain relief compared with tonic stimulation in a large prospective, randomized, controlled clinical trial. When the burst SCS pattern was electrically applied to the dorsal columns at adequate settings, it was effective at producing analgesia without the need for paresthesias. It was originally applied to the auditory cortex in an attempt to treat tinnitus with transcranial magnetic stimulation resistant to tonic stimuli. In contrast to other novel stimulus paradigms, burst SCS stems from original observations of thalamo-cortical firing patterns, which have the ability to strengthen synaptic connectivity. The concept of burst spinal cord stimulation (burst SCS), introduced in 2010 by DeRidder and colleagues, targets the dorsal columns in stimulus bursts comprised of five 1-ms pulses with an intraburst frequency of 500 Hz, delivered with a frequency of 40 Hz in a passive recharging paradigm to maintain charge balance across the electrical contacts ( Figure 1). However, during the past decade, a number of novel stimulus paradigms have been introduced for clinical use, resulting in improved outcomes and reduction in unwanted side effects. The conventional paradigm of SCS is to elicit comfortable paresthesias in the painful area using a tonic stimulus pattern at low frequencies (typically 30–70 Hz). Despite continuous improvement in the physical and functional aspects of implanted hardware and increased understanding of the limitations and possibilities of the treatment, the nature of the delivered stimulus to the spinal cord has remained unchanged for many years. More than five decades of clinical experience with electrostimulation of the dorsal columns (and adjacent dorsal neural structures) for intractable pain conditions have established this treatment in the armamentarium of pain practitioners, anesthesiologists, and neurosurgeons. The safety, efficacy, and cost-effectiveness of spinal cord stimulation have, in randomized controlled trials, been proven for failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), and painful diabetic neuropathy (PDN). Much of the challenge in the development in new pharmacotherapies results from the lack of knowledge or translation of research from animal to human species. Pharmacological treatments for neuropathic pain states are frequently ineffective, and opioid drugs, though effective in selective patients, may lead to harmful effect for both individuals and society. Despite of the immense burden that chronic pain has on patients, payers, and caregivers, it is rarely treated adequately and may even go untreated altogether.
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