The use of novel waveforms, frequencies, and stimulation modes in spinal cord stimulation (SCS) therapies may be more effective at relieving chronic low back pain and/or leg pain compared with traditional tonic low-frequency SCS, according to a review published in Current Pain and Headache Reports.

The researchers analyzed the results of several recent studies, including the SENZA-RTC study, the SUNBURST crossover trial, and the ongoing EVOLVE workflow retrospective multicenter study to compare traditional low-frequency tonic waveforms with modern high-frequency and burst stimulation for the treatment of chronic intractable low back pain and/or leg pain.

The SENZA-RCT trial included 198 participants with back and leg pain who were randomly assigned 1:1 to receive treatment with an investigational high-frequency, 10-kHz system or a commercially available SCS system. The paresthesia-free high-frequency SCS was found to be more effective compared with the low-frequency stimulation.

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The SUNBURST trial included 121 participants who were randomly assigned to receive tonic first/burst second or burst first/tonic second stimulation patterns. Participants indicated that they preferred high-frequency burst stimulation compared with low-frequency tonic SCS, that burst stimulation gave them better pain relief, and that they preferred a paresthesia-free SCS.

In the ongoing EVOLVE study, researchers are testing technology that can deliver both low-dose and high-dose SCS. This new technology can be better tailored to suit particular patient needs.

“Spinal cord stimulation is a major tool in the armamentarium of pain physicians to treat chronic pain and reduce opioid consumption. Physicians and patients now have multiple options of vendors and waveforms,” noted the review authors.

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Reference

Morales A, Yong RJ, Kaye AD, Urman RD. Spinal cord stimulation: comparing traditional low-frequency tonic waveforms to novel high frequency and burst stimulation for the treatment of chronic low back pain. [published online March 14, 2019]. Curr Pain Headache Rep. doi:10.1007/s11916-019-0763-3