Computational Analysis of Kilohertz Frequency Spinal Cord Stimulation for Chronic Pain Management
Computational Analysis of Kilohertz Frequency Spinal Cord Stimulation for Chronic Pain Management
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DOI：
10.1097/aln.0000000000000649
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发表时间：
2015-06-01
期刊：
影响因子：
8.8
通讯作者：
Machado, Andre G.
中科院分区：
文献类型：
--
作者：
Lempka, Scott F.;McIntyre, Cameron C.;Machado, Andre G.
背景：千赫兹脊髓刺激（KHFSCS）是一种治疗难治性神经性疼痛的新兴疗法。虽然KHFSCS有可能改善患有衰弱性疼痛的患者的生活，但其作用机制尚不清楚，因此难以优化其开发。因此，本研究的目的是利用计算机模型来研究KHFSCS对脊髓特定神经元件的直接影响。方法：该计算机模型由两个主要部分组成：(1)KHFSCS产生电场的有限元模型和(2)脊髓轴突的多室电缆模型。模型分析允许系统地研究许多变量（例如，背侧脑脊液厚度、导联位置、纤维侧支和纤维大小）及其对KHFSCS期间兴奋和传导阻滞阈值的相应影响。结果：本研究结果表明，大直径背柱或背根纤维的直接激发需要高刺激幅度，该刺激幅度在临床KHFSCS使用范围的上端或外（即0.5 ~ 5 mA）。传导阻滞仅在薄背脑脊液层的临床范围内可行。结论：这些结果提示临床KHFSCS可能不是通过背柱或背根纤维的直接激活或传导阻滞而起作用的。虽然这些结果需要进一步的研究来验证，但作者建议在检查KHFSCS的疼痛缓解机制时应考虑其他概念和/或替代假设。
Background: Kilohertz frequency spinal cord stimulation (KHFSCS) is an emerging therapy for treating refractory neuropathic pain. Although KHFSCS has the potential to improve the lives of patients experiencing debilitating pain, its mechanisms of action are unknown and thus it is difficult to optimize its development. Therefore, the goal of this study was to use a computer model to investigate the direct effects of KHFSCS on specific neural elements of the spinal cord.Methods: This computer model consisted of two main components: (1) finite element models of the electric field generated by KHFSCS and (2) multicompartment cable models of axons in the spinal cord. Model analysis permitted systematic investigation into a number of variables (e.g., dorsal cerebrospinal fluid thickness, lead location, fiber collateralization, and fiber size) and their corresponding effects on excitation and conduction block thresholds during KHFSCS.Results: The results of this study suggest that direct excitation of large-diameter dorsal column or dorsal root fibers require high stimulation amplitudes that are at the upper end or outside of the range used in clinical KHFSCS (i.e., 0.5 to 5 mA). Conduction block was only possible within the clinical range for a thin dorsal cerebrospinal fluid layer.Conclusions: These results suggest that clinical KHFSCS may not function through direct activation or conduction block of dorsal column or dorsal root fibers. Although these results should be validated with further studies, the authors propose that additional concepts and/or alternative hypotheses should be considered when examining the pain relief mechanisms of KHFSCS.