title: Burst spinal cord stimulation evaluated in patients with failed back surgery syndrome and painful diabetic neuropathy.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) is used for treating intractable neuropathic pain. Generally, it induces paresthesia in the area covered by SCS. Burst SCS was introduced as a new stimulation paradigm with good pain relief without causing paresthesia. Good results have been obtained in patients who were naive to SCS. In this study we assess the effectiveness of burst stimulation in three groups of chronic pain patients who are already familiar with SCS and the accompanying paresthesia.
  
  
  METHODS
  Forty-eight patients with at least six months of conventional, tonic stimulation tested burst stimulation for a period of two weeks. They were classified in three different groups: a cross-section of our population with painful diabetic neuropathy (PDN), a cross-section of our population with failed back surgery syndrome (FBSS), and FBSS patients who over time had become poor responders (PR) to SCS. Visual analog scale scores for pain were assessed prior to implantation, with tonic stimulation, and after two weeks of burst stimulation.
  
  
  RESULTS
  Burst stimulation reduced pain significantly for almost all patients. When compared with tonic stimulation, burst stimulation led to a significant additional pain reduction of on average 44% in patients with PDN (p < 0.001) and 28% in patients with FBSS (p < 0.01). Patients from the PR group benefitted less from burst stimulation on average. In addition, burst stimulation caused little or no paresthesia whereas tonic stimulation did induce paresthesia. Most patients preferred burst stimulation, but several preferred tonic stimulation because the paresthesia assured them that the SCS was working.
  
  
  CONCLUSIONS
  About 60% of the patients with tonic SCS experienced further pain reduction upon application of burst stimulation.
authors.affiliation: Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands; The Neurobionics Foundation, Enschede, The Netherlands.
authors.forename: Cecile C
authors.initials: CC
authors.lastname: de Vos
authors.forename: Marjanne J
authors.initials: MJ
authors.lastname: Bom
authors.forename: Sven
authors.initials: S
authors.lastname: Vanneste
authors.forename: Mathieu W P M
authors.initials: MW
authors.lastname: Lenders
authors.forename: Dirk
authors.initials: D
authors.lastname: de Ridder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000628:therapy*; D055111:Failed Back Surgery Syndrome / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000628:therapy*; D059408:Pain Management / Q000592:standards*; D010147:Pain Measurement / Q000592:standards*; D062187:Spinal Cord Stimulation / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Burst stimulation; diabetic neuropathic pain (DNP); failed back surgery syndrome (FBSS); paresthesia; spinal cord stimulation (SCS)