Background

Neuromodulation is a standard and well-accepted treatment for chronic refractory neuropathic pain. There has been progressive innovation in the field over the last decade, particularly in areas of spinal cord stimulation (SCS) and dorsal root ganglion stimulation. Improved outcomes using proprietary waveforms have become customary in the field, leading to an unprecedented expansion of these products and a plethora of options for the management of pain. Although advances in waveform technology have improved our fundamental understanding of neuromodulation, a scoping review describing new energy platforms and their associated clinical effects and outcomes is needed. The authors submit that understanding electrophysiological neuromodulation may be important for clinical decision-making and programming selection for personalized patient care.

Objective

This review aims to characterize ways differences in mechanism of action and clinical outcomes of current spinal neuromodulation products may affect contemporary clinical decision-making while outlining a possible path for the future SCS.

Study Design

The study is a scoping review of the literature about newer generation SCS waveforms.

Materials and Methods

A literature report was performed on PubMed and chapters to include articles on spine neuromodulation mechanism of action and efficacy.

Results

A total of 8469 studies were identified, 75 of which were included for the scoping review after keywords defining recent waveform technology were added.

Conclusions

Clinical data suggest that neuromodulation remains a promising tool in the treatment of chronic pain. The evidence for SCS for treating chronic pain seems compelling; however, more long-term and comparative data are needed for a comparison of waveforms when it comes to the etiology of pain. In addition, an exploration into combination waveform therapy and waveform cycling may be paramount for future clinical studies and the development of new technologies.

中文翻译：

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脊髓刺激的当前波形及其对神经调节未来的影响：范围界定综述

背景

神经调节是慢性难治性神经性疼痛的标准且广泛接受的治疗方法。过去十年，该领域不断取得进步，特别是在脊髓刺激 (SCS) 和背根神经节刺激领域。使用专有波形改善结果已成为该领域的惯例，导致这些产品空前扩展，并为疼痛管理提供了大量选择。尽管波形技术的进步提高了我们对神经调节的基本理解，但仍需要对新能源平台及其相关临床效果和结果进行范围审查。作者认为，了解电生理神经调节对于个性化患者护理的临床决策和编程选择可能很重要。

客观的

本综述旨在描述当前脊髓神经调节产品的作用机制和临床结果的差异可能影响当代临床决策的方式，同时概述未来 SCS 的可能路径。

学习规划

该研究是对新一代 SCS 波形文献的范围审查。

材料和方法

在 PubMed 和章节上进行了文献报告，其中包括有关脊柱神经调节作用机制和功效的文章。

结果

总共确定了 8469 项研究，其中 75 项在添加定义最新波形技术的关键词后纳入范围界定审查。

结论

临床数据表明，神经调节仍然是治疗慢性疼痛的有前途的工具。SCS 治疗慢性疼痛的证据似乎令人信服；然而，当涉及到疼痛的病因时，需要更多的长期和比较数据来比较波形。此外，对组合波形疗法和波形循环的探索对于未来的临床研究和新技术的开发可能至关重要。