Kilohertz Frequency Alternating Current Spinal Cord Stimulation for Chronic Pain Relief

 描述(申请人提供)：慢性疼痛是世界范围内最普遍的健康问题，通常没有得到充分的治疗。脊髓刺激(SCS)是一种广泛使用的、非破坏性的、可逆的治疗慢性疼痛的方法，特别是在其他保守治疗方法失败的情况下使用。最近，千赫频率交流电(KHFAC)SCS的使用显示出显著改善结果的潜力，但有报道称结果相互矛盾。KHFAC已被证明在周围神经中产生快速和可逆的传导阻滞。初步证据表明，KHFAC SCS可以在不伴随感觉异常的情况下缓解疼痛(与传统SCS不同)，因此人们对这种新方式产生了极大的兴奋。然而，KHFAC SCS可能产生疼痛缓解的机制，以及与传统SCS相比，在千赫兹频率下的神经反应之间的差异，人们知之甚少。我们假设，KHFAC SCS，正如目前实施的那样，不产生神经活动块，而是调节正在进行的神经活动。决定KHFAC SCS作用的关键因素从技术本身的细节开始，通过其对脊髓的作用延伸到对疼痛的有意识感知。通过这项研究的目的，我们期望展示KHFAC SCS早期临床成功(和失败)的机制，从而为神经调节领域提供关键信息。 我们进一步假设，KHFAC的独特功能，包括激活、阻断和调节神经结构中的活动的能力，可以通过专门设计利用这些功能的新型KHFAC SCS系统的开发来充分利用。这样的系统可能会对SCS的临床结果和应答率产生重大影响。KHFAC SCS可能代表着SCS领域在其40年历史上最令人兴奋的进步之一。如果成功，该项目将为治疗顽固性慢性疼痛的一种新的、强大的方式提供基础。

 DESCRIPTION (provided by applicant): Chronic pain is the most prevalent health problem worldwide and is often inadequately treated. Spinal cord stimulation (SCS) is a widely used, non-destructive, reversible therapy for treatment of chronic pain, particularly used when other conservative modalities have failed. Recently, the use of kilohertz frequency alternating current (KHFAC) SCS has shown potential for significantly improved outcomes, but conflicting results have been reported. KHFAC has been shown to produce a rapid and reversible conduction block in peripheral nerves. Preliminary evidence suggests that KHFAC SCS may produce pain relief without concomitant paresthesia (unlike conventional SCS), and thus significant excitement has been generated regarding this new modality. However, the mechanism by which KHFAC SCS might produce pain relief, and the differences between the neural response at kilohertz frequencies compared to conventional SCS, are poorly understood. We hypothesize that KHFAC SCS, as currently implemented, does not produce a block of neural activity but rather acts to modulate ongoing neural activity. The critical factors that determine the action of KHFAC SCS begin with the details of the technology itself, extend through its action on the spinal cord, and ultimately to the conscious perception of pain. Through the aims in this study, we anticipate demonstrating the mechanisms underlying the early clinical success (and failures) of KHFAC SCS, thus providing critical information for the field of neuromodulation. We further hypothesize that the unique features of KHFAC, which include the capacity to activate, block, and modulate activity in neural structures, could be fully exploited by the development of novel KHFAC SCS systems designed specifically to take advantage of these features. Such a system could have a significant impact on SCS clinical outcomes and responder rates. KHFAC SCS may represent one of the most exciting advances in the field SCS over its 40 year history. If successful, this project will provide the foundation for a new an powerful modality for the treatment of refractory chronic pain.