All included papers were peer reviewed, except two conference reports. Literature included both prospective and retrospective studies reporting clinical outcome measures when treating chronic pain using burst SCS, regardless of the underlying pain condition or length of treatment time. The reviewed literature was compiled by searching the MEDLINE and EMBASE databases using the search term “burst” combined with “dorsal column stimulation” or “spinal cord stimulation.” Google Scholar and the journal Neuromodulation were searched using the term “burst spinal cord stimulation.” Citation lists from contemporary reviews on spinal cord stimulation were also surveyed, and additional literature was added as appropriate. The purpose of this narrative review is to explore the available evidence for burst SCS spinal cord stimulation, providing a clinical perspective on the possible distinct therapy features, benefits, and limitations. During the interburst interval, a passive charge balance occurs that dissipates any charge imbalance that might occur across the electrodes.Īpart from affecting pain intensity, evidence suggests that burst SCS may impact important aspects of the chronic pain condition, such as pain vigilance, pain catastrophizing, and depression. Note the increasing pulse amplitude during the burst. Pulse trains are separated by an interburst interval of stimulation quiescence. īurst stimulation pattern and waveform signature. Most recently, burst SCS was shown to result in statistically superior pain relief compared with tonic stimulation in a large prospective, randomized, controlled clinical trial. When the burst SCS pattern was electrically applied to the dorsal columns at adequate settings, it was effective at producing analgesia without the need for paresthesias. It was originally applied to the auditory cortex in an attempt to treat tinnitus with transcranial magnetic stimulation resistant to tonic stimuli. In contrast to other novel stimulus paradigms, burst SCS stems from original observations of thalamo-cortical firing patterns, which have the ability to strengthen synaptic connectivity. The concept of burst spinal cord stimulation (burst SCS), introduced in 2010 by DeRidder and colleagues, targets the dorsal columns in stimulus bursts comprised of five 1-ms pulses with an intraburst frequency of 500 Hz, delivered with a frequency of 40 Hz in a passive recharging paradigm to maintain charge balance across the electrical contacts ( Figure 1). However, during the past decade, a number of novel stimulus paradigms have been introduced for clinical use, resulting in improved outcomes and reduction in unwanted side effects. The conventional paradigm of SCS is to elicit comfortable paresthesias in the painful area using a tonic stimulus pattern at low frequencies (typically 30–70 Hz). Despite continuous improvement in the physical and functional aspects of implanted hardware and increased understanding of the limitations and possibilities of the treatment, the nature of the delivered stimulus to the spinal cord has remained unchanged for many years. More than five decades of clinical experience with electrostimulation of the dorsal columns (and adjacent dorsal neural structures) for intractable pain conditions have established this treatment in the armamentarium of pain practitioners, anesthesiologists, and neurosurgeons. The safety, efficacy, and cost-effectiveness of spinal cord stimulation have, in randomized controlled trials, been proven for failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), and painful diabetic neuropathy (PDN). Much of the challenge in the development in new pharmacotherapies results from the lack of knowledge or translation of research from animal to human species. Pharmacological treatments for neuropathic pain states are frequently ineffective, and opioid drugs, though effective in selective patients, may lead to harmful effect for both individuals and society. Burst, Spinal Cord Stimulation, Outcomes, Clinical Introductionĭespite of the immense burden that chronic pain has on patients, payers, and caregivers, it is rarely treated adequately and may even go untreated altogether.
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