New modalities of neurostimulation: high frequency and dorsal root ganglion.

PURPOSE OF REVIEW: Neurostimulation is a well tolerated, cost-efficient, and effective method to treat chronic pain. Although spinal cord stimulation (SCS) has been shown to help patients, newer modalities such as burst, kilohertz-frequency, and dorsal root ganglion stimulation may provide greater pain relief, fewer paresthesias, and better outcomes. RECENT FINDINGS: Burst stimulation, programed as five-impulse burst at a frequency of 500 Hz, delivers more charge per second than conventional stimulation. Trials of burst stimulation have shown superior pain relief, decreased paresthesias, and patient preference compared with conventional SCS. Kilohertz-frequency SCS uses low-amplitude, high-frequency (10 kHz), and short-duration pulses. The SENZA trial showed superiority in both back and leg pain with greater pain relief as well as decreased opioid use. Dorsal root ganglion stimulation stimulates the ganglion cells allowing for precise targeting of pain regions. Multiple studies, including the ACCURATE trial, have shown superior pain relief in multiple conditions. SUMMARY: Improvements in pain control and patient satisfaction suggest that these new stimulation patterns will greatly increase the utility of neurostimulation; however, clinical trials with broader patient populations have to be done to support more extensive use of these therapies.

Duke Scholars

Author Lance Atlas Roy Anesthesiology, VA Anesthesiology Service