title: Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study.
abstract: OBJECTIVE
  Conventional spinal cord stimulation (SCS) delivers a tonic waveform with consistent stream of pulses; burst delivers groups of pulses separated by short pulse-free periods. The current study compared the short-term safety and efficacy of burst with tonic stimulation in subjects already receiving SCS.
  
  
  METHODS
  At 4 IRB-approved sites, 22 subjects previously implanted with an SCS device for intractable, chronic pain gave informed consent and received burst stimulation for 14 days. Subjects reported average daily Visual Analog Scale (VAS) for overall, trunk, and limb pain using tonic stimulation and after 7 and 14 days of burst stimulation. Thoughts about pain were assessed using the Pain Catastrophizing Scale. Areas of paresthesia were assessed during tonic and burst stimulation using body maps. Assessment of patient satisfaction and preferred stimulation occurred after 14 days of burst.
  
  
  RESULTS
  Average daily overall VAS reduced 46% from a mean of 53.5 (±20.2) mm during tonic SCS to 28.5 (±18.1) mm during burst (p < 0.001); trunk and limb VAS scores were also reduced by 33% and 51%, respectively. During burst, 16 subjects (73%) reported no paresthesia, 5 (23%) reported a reduction, and 1 (4%) reported increased paresthesia. After 14 days, 21 subjects (95%) reported being very satisfied or satisfied with burst. Burst was preferred by 20 subjects (91%), tonic by 1 (5%), and 1 (5%) reported no preference. Better pain relief was the most common reason cited for preference.
  
  
  CONCLUSIONS
  A majority of subjects reported improved pain relief using burst compared with tonic stimulation. Most subjects experienced less paresthesia during burst and preferred burst citing better pain relief.
authors: Melbourne Pain Group, Glen Waverly, Victoria, Australia.
authors: Peter
authors: P
authors: Courtney
authors: Benowa, Queensland, Australia.
authors: Anthony
authors: A
authors: Espinet
authors: Metro Spine Clinic, Caulfield South, Victoria, Australia.
authors: Bruce
authors: B
authors: Mitchell
authors: Hunter Pain Clinic, Newcastle, NSW, Australia.
authors: Marc
authors: M
authors: Russo
authors: Melbourne Pain Group, Glen Waverly, Victoria, Australia.
authors: Andrew
authors: A
authors: Muir
authors: Metro Spine Clinic, Caulfield South, Victoria, Australia.
authors: Paul
authors: P
authors: Verrills
authors: St. Jude Medical, Plano, TX, USA.
authors: Kristina
authors: http://orcid.org/0000-0002-1097-6811
authors: K
authors: Davis
mesh_terms: D000328:Adult; D000368:Aged; D001703:Biophysics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement; D062187:Spinal Cord Stimulation / Q000379:methods*; D013997:Time Factors
keywords: Burst stimulation; chronic pain; spinal cord stimulation; tonic stimulation