title: Is the introduction of another variable to the strength-duration curve necessary in neurostimulation?
abstract: BACKGROUND
  Neurostimulation is the process and technology derived from the application of electricity with different parameters to activate or inhibit nerve pathways. Pulse width (Pw) is the duration of each electrical impulse and, along with amplitude (I), determines the total energy charge of the stimulation.
  
  
  OBJECTIVE
  The aim of the study was to test Pw values to find the most adequate pulse widths in rechargeable systems to obtain the largest coverage of the painful area, the most comfortable paresthesia, and the greatest patient satisfaction.
  
  
  METHODS
  A study of the parameters was performed, varying Pw while maintaining a fixed frequency at 50 Hz. Data on perception threshold (Tp ), discomfort threshold (Td ), and therapeutic threshold (Tt ) were recorded, applying 14 increasing Pw values ranging from 50 µsec to 1000 µsec. Lastly, the behavior of the therapeutic range (TR), the coverage of the painful area, the subjective patient perception of paresthesia, and the degree of patient satisfaction were assessed.
  
  
  RESULTS
  The findings after analyzing the different thresholds were as follows: When varying the Pw, the differences obtained at each threshold (Tp , Tt , and Td ) were statistically significant (p < 0.05). The differences among the resulting Tp values and among the resulting Tt values were statistically significant when varying Pw from 50 up to 600 µsec (p < 0.05). For Pw levels 600 µsec and up, no differences were observed in these thresholds. In the case of Td , significant differences existed as Pw increased from 50 to 700 µsec (p ≤ 0.05). The coverage increased in a statistically significant way (p < 0.05) from Pw values of 50 µsec to 300 µsec. Good or very good subjective perception was shown at about Pw 300 µsec.
  
  
  CONCLUSIONS
  The patient paresthesia coverage was introduced as an extra variable in the chronaxie-rheobase curve, allowing the adjustment of Pw values for optimal programming. The coverage of the patient against the current chronaxie-rheobase formula will be represented on three axes; an extra axis (z) will appear, multiplying each combination of Pw value and amplitude by the percentage of coverage corresponding to those values. Using this new comparison of chronaxie-rheobase curve vs. coverage, maximum Pw values will be obtained different from those obtained by classic methods.
authors.affiliation: Pain Unit, Hospital Universitario Quirón Madrid, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Abejón
authors.forename: Pablo
authors.initials: P
authors.lastname: Rueda
authors.forename: Javier
authors.initials: J
authors.lastname: del Saz
authors.forename: Sara
authors.initials: S
authors.lastname: Arango
authors.forename: Eva
authors.initials: E
authors.lastname: Monzón
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D055592:Biophysical Phenomena / Q000502:physiology*; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000628:therapy; D010146:Pain; D017288:Pain Threshold / Q000502:physiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013116:Spinal Cord / Q000502:physiology*; D018709:Statistics, Nonparametric
keywords: Chronic pain; neurostimulation; perception threshold; programming strategies; spinal cord stimulation