Radiofrequency Spinal Cord Stimulation Provides Better Long-Term Pain Relief: Study

A research team led by scientists at the University of California San Diego School of Medicine while the findings of the research were published in the journal 'Bioelectronic Medicine'

Chronic pain spinal cord stimulation (SCS) uses an entrenched device to provide a small amount of electricity directly to the spinal cord, changing or blocking nerve activity and minimizing the sensation of pain reaching the brain, according to a new study.

A research team led by scientists at the University of California San Diego School of Medicine while the findings of the research were published in the journal ‘Bioelectronic Medicine’

High-frequency SCS was found to be more effective than low-frequency SCS in improving perceived pain reduction (PPR) in patients studied, with some variation in PPR between male and female patients.

In 1989, the U.S. Food and Drug Administration (FDA) approved low-frequency SCS (50 Hz) as a treatment for intractable back and leg pain. The FDA approved high-frequency SCS (10,000 Hz) in 2015, which delivers electrical stimulation pulses that are shorter in duration, lower in amplitude, and do not cause paresthesia, which is the abnormal sensation of tingling or prickling.

The newly published retrospective study looked at 237 patients who had SCS treatment between 2004 and 2020: There were 94 patients who received HF-SCS (40 females and 54 males) and 143 patients who did not (70 females and 73 males)

At three and six months post-implantation, the researchers found that PPR across all patients improved compared to baseline, but HF-SCS produced greater PPR than LF-SCS. HF-SCS was also associated with less subsequent use of opioids to mitigate pain.

Male PPR, for example, was significantly better for HF-SCS at three and six months when compared to LF-SCS, while this was only true for females at the 6 month time point.

LF-SCS males used more opioids post-implantation and at six months while females used more opioids post-implantation, at three, six and tended to use more opiates at the 12-month time-point.

At three and six months after implantation, the researchers discovered that PPR improved in all patients compared to baseline, but HF-SCS produced higher PPR than LF-SCS. HF-SCS was also linked to less subsequent use of opioids for pain relief.

Male PPR, for example, was significantly better for HF-SCS at three and six months when compared to LF-SCS, but only for females at six months.

Males used more opioids after implantation and at six months, whereas females used more opioids after implantation, at three, six, and tended to use more opiates at the 12-month time point.

“Our work was sparked by a growing literature that demonstrate sex specific immune pathways differentially contribute to chronic pain processes,” said senior author Imanuel Lerman, MD, an associate professor of anesthesiology, pain management specialist at UC San Diego Health, and an affiliate of the Qualcomm Institute.

“The observed parameter-specific (high versus low frequency) sex-based differences in spinal cord stimulation efficacy and opiate use are definitely intriguing.”

“It’s a first step in the right direction, but clearly more work needs to be done to carefully characterize sex specific pain regulatory pathways that may prove responsive to specific types of neuromodulation and or pharmaceutical therapies.”

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