IEEE Trans Neural Syst Rehabil Eng. 2023;31:4653-4660. doi: 10.1109/TNSRE.2023.3335100. Epub 2023 Nov 30.
This manuscript proposes an electrical definition of therapeutic dose for spinal-cord systems used for the treatment of chronic pain, analogous to the pharmacological definition. Dose-response relationships are fundamental to pharmacology, radio-therapy, and other treatments, but have never been properly established for neuromodulation. This manuscript offers a robust measure of dose, pre-requisite to establishing a reliable and repeatable dose-response relationship. The new definition, enabled by the system transresistance obtained from measurement of evoked action potentials, recognizes the mechanism of action of spinal cord stimulation (SCS), and should improve acceptance of the therapy as compared to pharmacological treatments which are currently used more frequently for the treatment of chronic pain. The new definition suggests methods for personalization and standardization of the dose in SCS, and is potentially generalizable to all neuromodulation therapies in which nervous tissue is excited including sacral nerve stimulation (SNS), vagal nerve stimulation (VNS) and deep-brain stimulation (DBS). Formulas are provided, and applied using patient data. Powerful conclusions are drawn from application of the new measure.
这篇手稿提出了一种用于治疗慢性疼痛的脊髓系统治疗剂量的电定义，类似于药理学定义。剂量-反应关系是药理学、放射治疗和其他治疗的基础，但从未在神经调节中得到适当确立。本文提供了一种强大的剂量衡量标准，是建立可靠和可重复的剂量-反应关系的前提。新的定义通过测量诱发动作电位获得的系统串联电阻来实现，它认识到脊髓刺激 (SCS) 的作用机制，并且应该比目前更频繁用于治疗慢性疼痛的药物治疗更能被接受。新的定义提出了个性化和标准化 SCS 剂量的方法，并且可能适用于所有兴奋神经组织的神经调节治疗，包括骶神经刺激 (SNS)、迷走神经刺激 (VNS) 和深部脑刺激 (DBS)。本文提供了公式，并应用于患者数据。从新测量方法的应用中得出了有力的结论。
