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.
RECENT FINDINGS: 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.