• T Wolter, A Kiemen, C Porzelius, and H Kaube.
• Interdisciplinary Pain Center, University Hospital Freiburg, Freiburg, Germany. tilman.wolter@uniklinik-freiburg.de
• Eur J Pain. 2012 May 1;16(5):648-55.

BackgroundRecent studies suggest that perception of the paraesthesia elicited by spinal cord stimulation (SCS) is not necessarily required for the pain relieving effect.ObjectiveThe purpose of the study was to determine the effect of sub-perception threshold SCS in patients with neuropathic pain.MethodsTen patients with implanted SCS systems underwent continuous sub-threshold stimulation and no stimulation in a blinded randomized crossover design. Pain scores under these treatment modalities were compared with usual supra-threshold stimulation.ResultsSub-threshold stimulation elicited significantly lower pain relief than supra-perception threshold SCS. Mean pain scores were 3.6 [max 6.3, min 1.9, standard deviation (SD) 1.3] under supra-threshold stimulation, 5.6 (max 9.0, min 2.4, SD 1.9) under sub-threshold stimulation and 6.4 (max 10.0, min 4.0, SD 2.0) without stimulation.ConclusionSub-threshold stimulation under otherwise conventional stimulation parameters has a measurable but not clinically sufficient effect. Thus, the pain relieving effect elicited by SCS is not necessarily linked to the perceptibility of stimulation but may instead be attributed to the intensity of the electric field.© 2011 European Federation of International Association for the Study of Pain Chapters.

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