Background: High-frequency stimulation (HFS) has recently gained attention as an alternative to parameters used in traditional spinal cord stimulation (SCS). Because HFS is paresthesia free, the gate theory of pain control as a basis of SCS has been called into question. The mechanism of action of HFS remains unclear. Objective: We compare the effects of HFS and traditional SCS on quantitative sensory testing parameters to provide insight into how HFS modulates the nervous system. Methods: Using quantitative sensory testing, we measured thermal detection and pain thresholds and mechanical detection and pressure pain thresholds, as well as vibratory detection, in 20 SCS patients off stimulation (OFF), on traditional stimulation (ON) and on HFS in a randomized order. Results: HFS significantly increased the mechanical detection threshold compared to OFF stimulation (p < 0.001) and traditional SCS (p = 0.01). Pressure pain detection and vibratory detection thresholds also significantly increased with HFS compared to ON states (p = 0.04 and p = 0.01, respectively). In addition, HFS significantly decreased 10- and 40-gram pinprick detection compared to OFF states (both p = 0.01). No significant differences between OFF, ON and HFS states were seen in thermal and thermal pain detection. Conclusion: HFS is a new means of modulating chronic pain. The mechanism by which HFS works seems to differ from that of traditional SCS, offering a new platform for innovative advancements in treatment and a greater potential to treat patients by customizing waveforms.

Keywords:
High-frequency stimulation, Spinal cord stimulation, Quantitative sensory testing, Mechanical detection thresholds, Thermal thresholds, Pressure pain thresholds, Vibratory detection, Chronic pain
1.
Grabow TS, Tella PK, Raja SN: Spinal cord stimulation for complex regional pain syndrome: an evidence-based medicine review of the literature. Clin J Pain 2003;19:371-383.
2.
Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O'Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB: Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicenter randomized controlled trial in patients with failed back surgery syndrome. Pain 2007;132:179-188.
3.
Zhang T, Janik J, Grill W: Mechanisms and models of spinal cord stimulation for the treatment of neuropathic pain. Brain Res 2014;1569:19-31.
4.
Perruchoud C, Eldabe S, Batterham AM, Madzinga G, Brookes M, Durrer A, Rosato M, Bovet N, West S, Bovy M, Rutschmann B, Gulve A, Garner F, Buchser E: Analgesic efficacy of high-frequency spinal cord stimulation: a randomized double-blind placebo-controlled study. Neuromodulation 2013;16:363-369.
5.
Shechter R, Yang F, Xu Q, Cheong Y, He S, Sdrulla A, Carteret A, Wacnik P, Dong X, Meyer R, Raja S, Guan Y: Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain. Anesthesiology 2013;119:422-432.
6.
Van Buyten JP, Al-Kaisy A, Smet I, Palmisani S, Smith T: High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study. Neuromodulation 2013;16:59-65; discussion 65-66.
7.
Eisenberg E, Backonja MM, Fillingim R, Pud D, Hord D, King G, Stojanovic M: Quantitative sensory testing for spinal cord stimulation in patients with chronic neuropathic pain. Pain Pract 2006;6:161-165.
8.
Al-Kaisy A, Van Buyten JP, Smet I, Palmisani S, Pang D, Smith T: Sustained effectiveness of 10-kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Pain Med 2014;15:347-354.
9.
Son B, Kim D, Lee S, Chough C: Factors associated with the success of trial spinal cord stimulation in patients with chronic pain from failed back surgery syndrome. J Korean Neurosurg Soc 2013;54:501-506.
10.
Taylor, R. S., Desai MJ, Rigoard P, Taylor RJ: Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis. Pain Pract 2014;14:489-505.
11.
Baker L, Bowman B, McNeal D: Effects of waveform on comfort during neuromuscular electrical stimulation. Clin Orthop Relat Res 1988;233:75-85.
12.
DeBock F, Dirckx J, Wyndaele J: Evaluating the use of different waveforms for intravesical electrical stimulation: a study in the rat. Neurol Urodyn 2011;30:169-173.
13.
Kantor G, Alon G, Ho H: The effects of selected stimulus waveforms on pulse and phase characteristics at sensory and motor thresholds. Phys Ther 1994;74:951-962.
14.
Kumar K, Caraway D, Rizvi S, Bishop S: Current challenges in spinal cord stimulation. Neuromodulation 2014;17(suppl 1):22-35.
15.
Khoo HM, Kishima H, Oshino S, Yoshimine T: Low-frequency subthalamic nucleus stimulation in Parkinson's disease: a randomized clinical trial. Mov Disord 2014;29:270-274.
16.
Rasche D, Ruppolt MA, Kress B, Unterberg A, Tronnier VM: Quantitative sensory testing in patients with chronic unilateral radicular neuropathic pain and active spinal cord stimulation. Neuromodulation 2006;9:239-247.
17.
Munster T, Tiebel N, Seyer H, Maihofner C: Modulation of somatosensory profiles by spinal cord stimulation in primary Raynaud's syndrome. Pain Pract 2012;12:469-475.
© 2015 S. Karger AG, Basel
2015
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