Ahmed Shaheen, Yearwood Thomas, De Ridder Dirk, Vanneste Sven
a Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences , The University of Texas at Dallas , Dallas , TX , USA.
b Pain Consultants ASC , Pascagoula , MS , USA.
Expert Rev Med Devices. 2018 Jan;15(1):61-70. doi: 10.1080/17434440.2018.1418662. Epub 2017 Dec 20.
Paresthesia-free spinal cord stimulation (SCS) techniques, such as burst and high-frequency (HF) SCS, have been developed and demonstrated to be successful for treating chronic pain, albeit via different mechanisms of action. The goal of this review is to discuss the mechanisms of action for pain suppression at both the cellular and systems levels for burst and HF SCS. In addition, we also discuss the neuromodulation devices that mimic these paradigms.
The authors performed a literature review to unravel the mechanisms of action for burst and HF SCS coupled with booklets and user manuals from neuromodulation companies to understand the programmable parameters and operating ranges. Burst SCS modulates the medial pathway to suppress pain. On cellular level, burst SCS is independent on activation of γ-aminobutyric acid (GABA) receptors to inhibit neuronal firing. HF SCS blocks large-diameter fibers from producing action potentials with little influence on smaller fibers, increasing pain suppression as frequency increases.
The neuromodulation industry is in a phase of intense innovation characterized by adaptive stimulation to improve patients' experience and experiment with alternative frequencies and novel stimulation targets.
无感觉异常的脊髓刺激（SCS）技术，如脉冲串和高频（HF）SCS，已被开发出来，并已证明对治疗慢性疼痛是成功的，尽管其作用机制不同。本综述的目的是在细胞和系统水平上讨论脉冲串和高频SCS抑制疼痛的作用机制。此外，我们还将讨论模拟这些模式的神经调节装置。
作者进行了文献综述，以揭示脉冲串和高频SCS的作用机制，并结合神经调节公司的手册和用户手册，了解可编程参数和操作范围。脉冲串SCS调节内侧通路以抑制疼痛。在细胞水平上，脉冲串SCS独立于γ-氨基丁酸（GABA）受体的激活来抑制神经元放电。高频SCS阻止大直径纤维产生动作电位，对较小纤维影响很小，随着频率增加，疼痛抑制作用增强。
神经调节行业正处于一个激烈创新的阶段，其特点是采用适应性刺激来改善患者体验，并尝试不同频率和新的刺激靶点。
