• Krishnan Chakravarthy, Hira Richter, Paul J Christo, Kayode Williams, and Yun Guan.
• Department of Anesthesiology and Pain Medicine, University of California San Diego Health System, San Diego, CA, USA.
• Neuromodulation. 2018 Jan 1; 21 (1): 10-18.

BackgroundTraditional spinal cord stimulation (SCS) requires that paresthesia overlaps chronic painful areas. However, the new paradigm high-frequency SCS (HF-SCS) does not rely on paresthesia.Study DesignA review of preclinical and clinical studies regarding the use of paresthesia-free HF-SCS for various chronic pain states.MethodsWe reviewed available literatures on HF-SCS, including Nevro's paresthesia-free ultra high-frequency 10 kHz therapy (HF10-SCS). Data sources included relevant literature identified through searches of PubMed, MEDLINE/OVID, and SCOPUS, and manual searches of the bibliographies of known primary and review articles.Outcome MeasuresThe primary goal is to describe the present developing conceptions of preclinical mechanisms of HF-SCS and to review clinical efficacy on paresthesia-free HF10-SCS for various chronic pain states.ResultsHF10-SCS offers a novel pain reduction tool without paresthesia for failed back surgery syndrome and chronic axial back pain. Preclinical findings indicate that potential mechanisms of action for paresthesia-free HF-SCS differ from those of traditional SCS.ConclusionsTo fully understand and utilize paresthesia-free HF-SCS, mechanistic study and translational research will be very important, with increasing collaboration between basic science and clinical communities to design better trials and optimize the therapy based on mechanistic findings from effective preclinical models and approaches. Future research in these vital areas may include preclinical and clinical components conducted in parallel to optimize the potential of this technology.© 2017 International Neuromodulation Society.

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