Back to Search
Start Over
Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the Dorsal Root Ganglion
- Source :
- Neuromodulation, 24, 738-745, Neuromodulation, 24, 4, pp. 738-745
- Publication Year :
- 2021
-
Abstract
- Item does not contain fulltext BACKGROUND: Dorsal root ganglion stimulation (DRG-S) involves the electrical modulation of the somata of afferent neural fibers to treat chronic pain. DRG-S has demonstrated clinical efficacy at frequencies lower than typically used with spinal cord stimulation (SCS). In a clinical study, we found that the frequency of DRG-S can be tapered to a frequency as low as 4 Hz with no loss of efficacy. This review discusses possible mechanisms of action underlying effective pain relief with very low-frequency DRG-S. MATERIALS AND METHODS: We performed a literature review to explore the role of frequency in neural transmission and the corresponding relevance of frequency settings with neuromodulation. FINDINGS: Sensory neural transmission is a frequency-modulated system, with signal frequency determining which mechanisms are activated in the dorsal horn. In the dorsal horn, low-frequency signaling (25 Hz) are excitatory. Physiologically, low-threshold mechanoreceptors (LTMRs) fibers transmit or modulate innocuous mechanical touch at frequencies as low as 0.5-5 Hz, while nociceptive fibers transmit pain at high frequencies. We postulate that very low-frequency DRG-S, at least partially, harnesses LTMRs and the native endogenous opioid system. Utilizing lower stimulation frequency decreases the total energy delivery used for DRG-S, extends battery life, and facilitates the development of devices with smaller generators.
- Subjects :
- Sensory system
Stimulation
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
03 medical and health sciences
0302 clinical medicine
Nerve Fibers
Dorsal root ganglion
Ganglia, Spinal
medicine
Humans
Pain Management
Endogenous opioid
Spinal Cord Stimulation
business.industry
Chronic pain
General Medicine
medicine.disease
Neuromodulation (medicine)
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Nociception
nervous system
Neurology
Excitatory postsynaptic potential
Neurology (clinical)
Chronic Pain
business
Neuroscience
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 10947159
- Database :
- OpenAIRE
- Journal :
- Neuromodulation, 24, 738-745, Neuromodulation, 24, 4, pp. 738-745
- Accession number :
- edsair.doi.dedup.....72ec8955876a3558c6e765346f709c3d