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Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain.

ABSTRACT: Spinal cord stimulation (SCS) is a useful neuromodulatory technique for treatment of certain neuropathic pain conditions. However, the optimal stimulation parameters remain unclear.In rats after L5 spinal nerve ligation, the authors compared the inhibitory effects on mechanical hypersensitivity from bipolar SCS of different intensities (20, 40, and 80% motor threshold) and frequencies (50, 1 kHz, and 10?kHz). The authors then compared the effects of 1 and 50 Hz dorsal column stimulation at high- and low-stimulus intensities on conduction properties of afferent A?/?-fibers and spinal wide-dynamic-range neuronal excitability.Three consecutive daily SCS at different frequencies progressively inhibited mechanical hypersensitivity in an intensity-dependent manner. At 80% motor threshold, the ipsilateral paw withdrawal threshold (% preinjury) increased significantly from pre-SCS measures, beginning with the first day of SCS at the frequencies of 1?kHz (50.2?±?5.7% from 23.9?±?2.6%, n = 19, mean ± SEM) and 10?kHz (50.8?±?4.4% from 27.9?±?2.3%, n = 17), whereas it was significantly increased beginning on the second day in the 50 Hz group (38.9?±?4.6% from 23.8?±?2.1%, n = 17). At high intensity, both 1 and 50 Hz dorsal column stimulation reduced A?/?-compound action potential size recorded at the sciatic nerve, but only 1?kHz stimulation was partially effective at the lower intensity. The number of actions potentials in C-fiber component of wide-dynamic-range neuronal response to windup-inducing stimulation was significantly decreased after 50 Hz (147.4?±?23.6 from 228.1?±?39.0, n = 13), but not 1?kHz (n = 15), dorsal column stimulation.Kilohertz SCS attenuated mechanical hypersensitivity in a time course and amplitude that differed from conventional 50 Hz SCS, and may involve different peripheral and spinal segmental mechanisms.

SUBMITTER: Shechter R

PROVIDER: S-EPMC3763697 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain.

Shechter Ronen R Yang Fei F Xu Qian Q Cheong Yong-Kwan YK He Shao-Qiu SQ Sdrulla Andrei A Carteret Alene F AF Wacnik Paul W PW Dong Xinzhong X Meyer Richard A RA Raja Srinivasa N SN Guan Yun Y

Anesthesiology 20130801 2

<h4>Background</h4>Spinal cord stimulation (SCS) is a useful neuromodulatory technique for treatment of certain neuropathic pain conditions. However, the optimal stimulation parameters remain unclear.<h4>Methods</h4>In rats after L5 spinal nerve ligation, the authors compared the inhibitory effects on mechanical hypersensitivity from bipolar SCS of different intensities (20, 40, and 80% motor threshold) and frequencies (50, 1 kHz, and 10 kHz). The authors then compared the effects of 1 and 50 Hz ...[more]

PMID: 23880991

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Project description:INTRODUCTION:Kilohertz frequency spinal cord stimulation (kHz-SCS) deposits significantly more power in tissue compared to SCS at conventional frequencies, reflecting increased duty cycle (pulse compression). We hypothesize kHz-SCS increases local tissue temperature by joule heat, which may influence the clinical outcomes. METHODS:To establish the role of tissue heating in KHZ-SCS, a decisive first step is to characterize the range of temperature changes expected during conventional and KHZ-SCS protocols. Fiber optic probes quantified temperature increases around an experimental SCS lead in a bath phantom. These data were used to verify a SCS lead heat-transfer model based on joule heat. Temperature increases were then predicted in a seven-compartment (soft tissue, vertebral bone, fat, intervertebral disc, meninges, spinal cord with nerve roots) geometric human spinal cord model under varied parameterization. RESULTS:The experimentally constrained bio-heat model shows SCS waveform power (waveform RMS) determines tissue heating at the spinal cord and surrounding tissues. For example, we predict temperature increased at dorsal spinal cord of 0.18-1.72?°C during 3.5?mA peak 10?KHz stimulation with a 40-10-40 ?s biphasic pulse pattern, 0.09-0.22?°C during 3.5?mA 1?KHz 100-100-100 ?s stimulation, and less than 0.05?°C during 3.5?mA 50?Hz 200-100-200 ?s stimulation. Notably, peak heating of the spinal cord and other tissues increases superlinearly with stimulation power and so are especially sensitive to incremental changes in SCS pulse amplitude or frequency (with associated pulse compression). Further supporting distinct SCS intervention strategies based on heating; the spatial profile of temperature changes is more uniform compared to electric fields, which suggests less sensitivity to lead position. CONCLUSIONS:Tissue heating may impact short and long-term outcomes of KHZ-SCS, and even as an adjunct mechanism, suggests distinct strategies for lead position and programming optimization.

Dataset Information

Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain.

Publications

Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain.

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