title: New modalities of neurostimulation: high frequency and dorsal root ganglion.
abstract: OBJECTIVE
  Neurostimulation is a well tolerated, cost-efficient, and effective method to treat chronic pain. Although spinal cord stimulation (SCS) has been shown to help patients, newer modalities such as burst, kilohertz-frequency, and dorsal root ganglion stimulation may provide greater pain relief, fewer paresthesias, and better outcomes.
  
  
  RESULTS
  Burst stimulation, programed as five-impulse burst at a frequency of 500 Hz, delivers more charge per second than conventional stimulation. Trials of burst stimulation have shown superior pain relief, decreased paresthesias, and patient preference compared with conventional SCS. Kilohertz-frequency SCS uses low-amplitude, high-frequency (10 kHz), and short-duration pulses. The SENZA trial showed superiority in both back and leg pain with greater pain relief as well as decreased opioid use. Dorsal root ganglion stimulation stimulates the ganglion cells allowing for precise targeting of pain regions. Multiple studies, including the ACCURATE trial, have shown superior pain relief in multiple conditions.
  
  
  CONCLUSIONS
  Improvements in pain control and patient satisfaction suggest that these new stimulation patterns will greatly increase the utility of neurostimulation; however, clinical trials with broader patient populations have to be done to support more extensive use of these therapies.
authors.affiliation: aDepartment of Anesthesiology, Duke University Medical Center bDuke University School of Medicine, Durham cWake Forest University School of Medicine, The Center for Clinical Research, Carolinas Pain Institute, Winston-Salem, North Carolina, USA.
authors.forename: Lance A
authors.initials: LA
authors.lastname: Roy
authors.forename: Rathnayaka Mudiyanselage Kalpanee D
authors.initials: RM
authors.lastname: Gunasingha
authors.forename: Richard
authors.initials: R
authors.lastname: Rauck
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D002986:Clinical Trials as Topic; D005727:Ganglia, Spinal / Q000502:physiology*; D006801:Humans; D010292:Paresthesia / Q000209:etiology; D062187:Spinal Cord Stimulation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome