Neural Recruitment During Conventional, Burst, and 10-kHz Spinal Cord Stimulation for Pain.
Neural Recruitment During Conventional, Burst, and 10-kHz Spinal Cord Stimulation for Pain.
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DOI：
10.1016/j.jpain.2021.09.005
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Lempka SF
中科院分区：
文献类型：
--
作者：
Rogers ER;Zander HJ;Lempka SF
脊髓刺激(SCS)是治疗严重慢性疼痛的一种流行的神经刺激疗法。为了提高刺激效果，现在临床上使用了多种模式，包括传统的、突发的和10 kHz的SCS。临床观察推测，这些模式针对不同的神经元件和/或通过不同的作用机制发挥作用。然而，在人类身上，这些假说不能通过实验方法得出结论。因此，我们利用计算模型来评估初级传入神经元、中间神经元和投射神经元对常规、突发性和10 kHzSCS的反应。我们发现，局部细胞阈值总是高于传入阈值，反对直接招募这些局部细胞。此外，尽管我们观察到常规、突发和10 kHzSCS之间的相对阈值差异，但招募顺序是相同的。最后，与以前的报道相反，轴突侧化使初级传入的激活阈值发生了复杂的变化。这些结果推动了未来跨SCS范例的临床观察的背景研究工作。
Spinal cord stimulation (SCS) is a popular neurostimulation therapy for severe chronic pain. To improve stimulation efficacy, multiple modes are now used clinically, including conventional, burst, and 10-kHz SCS. Clinical observations have produced speculation that these modes target different neural elements and/or work via distinct mechanisms of action. However, in humans, these hypotheses cannot be conclusively answered via experimental methods. Therefore, we utilized computational modeling to assess the response of primary afferents, interneurons, and projection neurons to conventional, burst, and 10-kHz SCS. We found that local cell thresholds were always higher than afferent thresholds, arguing against direct recruitment of these local cells. Furthermore, although we observed relative threshold differences between conventional, burst, and 10-kHz SCS, the recruitment order was the same. Finally, contrary to previous reports, axon collateralization produced complex changes in activation thresholds of primary afferents. These results motivate future work to contextualize clinical observations across SCS paradigms.
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