Tonic, Burst, High-Density, and 10-kHz High-Frequency Spinal Cord Stimulation: Efficiency and Patients' Preferences in a Failed Back Surgery Syndrome Predominant Population. Review of Literature

BACKGROUND: Spinal cord stimulation (SCS) is a neuromodulation process to treat neuropathic pain, initially developed on tonic paresthesia-based stimulation. In the last decade, 3 major paresthesia-free SCSs have emerged. Several studies show their superiority over tonic stimulation. OBJECTIVE: We summarize the data on SCS efficacy and patients' preferences. METHODS: We selected studies from the last decade to clarify whether the different paresthesia-free SCSs are superior to tonic or not and for which SCS the patient has a preference. Study selection was focused on a failed back surgery syndrome predominant population. RESULTS: SCS is an effective way to treat intractable neuropathic pain of the limbs and back, compared with conventional medical management and reoperation. Paresthesia-free SCSs as burst, high-density, and 10-kHz frequency are equal to tonic SCS in some studies and superior in most. Analysis of patients' preferences shows a clear trend toward paresthesia-free SCS. CONCLUSIONS: Recent studies show superiority of paresthesia-free SCS compared with tonic SCS and those results are corroborated by analysis of patients' preferences. Taking these data into account should motivate physicians to opt for multimodal capable devices before implanting SCS.