Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Curr Pain Headache Rep. 2019 Mar 14;23(4):25. doi: 10.1007/s11916-019-0763-3.
The purpose of the present investigation is to summarize supporting evidence for novel sub-perception spinal cord stimulation (SCS) therapy over traditional paresthesia inducing low-frequency waveforms for the treatment of chronic pain. The focus of this review is to summarize key studies comparing traditional low-frequency tonic waveforms to modern high frequency and burst stimulation for the treatment of patients with chronic intractable low back pain and/or leg pain.
Several recent studies have demonstrated the benefit of novel SCS therapies over traditional low-frequency SCS for the treatment of patients with chronic low back and/or leg pain. SENZA-RTC showed that paresthesia-free high-frequency SCS was superior to low-frequency stimulation for treatment of chronic low back pain with leg pain. The SUNBURST crossover trial recently found that high-frequency burst stimulation was preferred over low-frequency tonic SCS with patients citing better pain relief and a preference for paresthesia-free SCS. The new ongoing EVOLVE workflow retrospective multicenter study uses technology that can deliver both low-dose and high-dose SCS. Further, the wavewriter technology addresses patient variability with its ability to layer sub-perception waveforms and paresthesia inducing low-frequency stimulation tailored to patient needs via an interactive feedback feature. Neuromodulation for the treatment of chronic pain is rapidly evolving with technology at its forefront. Modern SCS systems use novel waveforms, frequencies, and stimulation modes to deliver paresthesia-free pain relief to patients suffering from chronic low back pain and/or leg pain with better results than traditional tonic low-frequency SCS. As the field advances, new studies are needed comparing new waveform and delivery systems to optimize patient selection and treatment response.
本研究旨在总结新型亚感知脊髓刺激（SCS）治疗在慢性疼痛治疗中优于传统诱发感觉的低频波形的支持证据。本综述的重点是总结比较传统低频连续波与现代高频和爆发刺激治疗慢性难治性腰痛和/或腿痛患者的关键研究。
几项最近的研究表明，新型 SCS 疗法优于传统低频 SCS，可治疗慢性腰痛和/或腿痛患者。SENZA-RTC 研究表明，无感觉高频 SCS 优于低频刺激，可治疗伴有腿部疼痛的慢性腰痛。最近的 SUNBURST 交叉试验发现，高频爆发刺激优于低频连续波 SCS，患者表示疼痛缓解更好，更喜欢无感觉的 SCS。正在进行的 EVOLVE 工作流程回顾性多中心研究使用既能提供低剂量又能提供高剂量 SCS 的技术。此外，通过交互反馈功能，WaveWriter 技术可以分层亚感知波形和诱发感觉的低频刺激，根据患者的需求进行定制，从而解决患者的变异性。神经调节治疗慢性疼痛正在迅速发展，技术处于前沿。现代 SCS 系统使用新型波形、频率和刺激模式为慢性腰痛和/或腿痛患者提供无感觉的疼痛缓解，其疗效优于传统的连续低频 SCS。随着该领域的发展，需要进行新的研究比较新的波形和输送系统，以优化患者选择和治疗反应。
