Comparison of Burst and Tonic Spinal Cord Stimulation on Spinal Neural Processing in an Animal Model

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Comparison of Burst and Tonic Spinal Cord Stimulation on Spinal Neural Processing in an Animal Model

1. Rurong Tang MD, PhD^1,4,
2. Marte Martinez MD²,
3. Melanie Goodman-Keiser PhD³,
4. Jay P. Farber PhD¹,
5. Chao Qin MD, PhD^1,† and
6. Robert D. Foreman PhD^1,2,*

Article first published online: 24 SEP 2013

DOI: 10.1111/ner.12117

© 2013 International Neuromodulation Society

Issue

Neuromodulation: Technology at the Neural Interface

Volume 17, Issue 2, pages 143–151, February 2014

Additional Information(Show All)

How to CiteAuthor InformationPublication HistoryFunding Information

1. For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/bw/submit.asp?ref=1094-7159&site=1
2. Source of funding: St. Jude Medical Neuromodulation Division
3. Conflict of Interest: Robert D. Foreman is a consultant for St. Jude Medical, and Respicardia. Dr. Foreman also has contracts with St. Jude Medical and Boston Scientific. Dr. Melanie Goodman-Keiser is an employee of St. Jude Medical Neuromodulation.

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Keywords:

• Basic science;
• nociceptive pain;
• paresthesia;
• spinal cord stimulation;
• visceral pain

Objectives

Spinal cord stimulation (SCS) using bursts of pulses suppressed neuropathic pain as well or better than tonic stimulation and limited the incidences of parasthesias. The present translational study explored possible differences in mechanisms of burst and tonic SCS on nociceptive spinal networks and/or the gracile nucleus supraspinal relay.

Materials and Methods

Visceromotor reflexes (VMRs, a nociceptive response) or extracellular activity of either L6-S2 spinal neurons or gracile nucleus neurons were recorded during noxious somatic stimulation (pinching) and visceral stimulation (colorectal distension [CRD]) in anesthetized rats. A stimulating (unipolar, ball) electrode at L2-L3 delivered 40 Hz burst or tonic SCS at different intensities relative to motor threshold (MT).

Results

Average MTs for burst SCS were significantly lower than for tonic SCS. Burst SCS reduced the VMR more than tonic SCS. After high-intensity SCS (90% MT), spinal neuronal responses to CRD and pinch were reduced similarly for burst and tonic SCS. At low-intensity SCS (60% MT), only burst SCS significantly decreased the nociceptive somatic response. Tonic but not burst SCS significantly increased spontaneous activity of neurons in the gracile nucleus.

Conclusion

Based on the clinically relevant burst versus tonic parameters used in this study, burst SCS is more efficacious than tonic SCS in attenuating visceral nociception. Burst and tonic SCS also suppress lumbosacral neuronal responses to noxious somatic and visceral stimuli; however, burst SCS has a greater inhibitory effect on the neuronal response to noxious somatic stimuli than to noxious visceral stimuli. Reduced or abolished paresthesia in patients may be due in part to burst SCS not increasing spontaneous activity of neurons in the gracile nucleus.