• Mehul J Desai, John Salmon, Paul Verrills, Bruce Mitchell, Neels Du Toit, Dan Bates, Girish Vajramani, Adam Williams, Sarah Love-Jones, Nikunj Patel, Serge Nikolic, Vivek Mehta, Alia Ahmad, James Yu, Nick Christellis, Sam Harkin, Ganesan Baranidharan, Robert Levy, Peter Staats, Mark N Malinowski, James Makous, Nicholas Sullivan, Shilpa Kottalgi, Melissa Hartley, and Lakshmi Narayan Mishra.
• International Spine, Pain & Performance Center, Washington, DC, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA. Electronic address: drdesai@isppcenter.com.
• Neuromodulation. 2023 Jan 1; 26 (1): 182191182-191.

ObjectivesThe aim of this article is to discuss the possible mechanisms of action (MOAs) and results of a pilot study of a novel, anatomically placed, and paresthesia-independent, neurostimulation waveform for the management of chronic intractable pain.Materials And MethodsA novel, multilayered pulsed stimulation pattern (PSP) that comprises three temporal layers, a Pulse Pattern layer, Train layer, and Dosage layer, was developed for the treatment of chronic intractable pain. During preliminary development, the utility was evaluated of anatomical PSP (aPSP) in human subjects with chronic intractable pain of the leg(s) and/or low back, compared with that of traditional spinal cord stimulation (T-SCS) and physiological PSP. The scientific theory and testing presented in this article provide the preliminary justification for the potential MOAs by which PSP may operate.ResultsDuring the pilot study, aPSP (n = 31) yielded a greater decrease in both back and leg pain than did T-SCS (back: -60% vs -46%; legs: -63% vs -43%). In addition, aPSP yielded higher responder rates for both back and leg pain than did T-SCS (61% vs 48% and 78% vs 50%, respectively).DiscussionThe novel, multilayered approach of PSP may provide multimechanistic therapeutic relief through preferential fiber activation in the dorsal column, optimization of the neural onset response, and use of both the medial and lateral pathway through the thalamic nuclei. The results of the pilot study presented here suggest a robust responder rate, with several subjects (five subjects with back pain and three subjects with leg pain) achieving complete relief from PSP during the acute follow-up period. These clinical findings suggest PSP may provide a multimechanistic, anatomical, and clinically effective management for intractable chronic pain. Because of the limited sample size of clinical data, further testing and long-term clinical assessments are warranted to confirm these preliminary findings.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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