Sasaki J., Schade C.M., M.D., Ph.D., Shultz, D. et al. American Academy of Pain Medicine Annual Meeting Abstracts: Preference for voltage or current stimulation pulse trains is not consistent in patients undergoing spinal cord stimulation (SCS) trial (#161). Pain Medicine 2009; 10(1):228.

  • Primary Presenter: John Sasaki, MD;
  • Primary Presenter Institution: John Sasaki, M.D., Inc.
  • Presenting author’s full street address and e-mail address:
  • Building 1A
  • 255 East Bonita Avenue
  • Pomona, California 91769
  • johnsasakimd@mac.com

Title: Preference for voltage or current stimulation pulse trains is not consistent in patients undergoing spinal cord stimulation (SCS) trial.

Introduction

Commercially available SCS devices control the energy delivered to neural tissue through constant voltage (CV) or constant current (CC) stimulation in order to cause the sensation of paresthesia. This study aimed to determine 1) if initially indicated preference for CV or CC corresponded with the outcome of a randomized trial and, 2) whether patients could correctly identify identical and different pulse trains.

Materials and Methods

In this IRB-approved multicenter feasibility study, 14 patients received stimulation alternating between CV and CC and specified whether they preferred either sensation. Subsequently, each patient also received 20 randomly presented pairs of 15-second pulse trains. Patients identified whether the two pulse trains were the same or different, and if they preferred the first or second train. Patients were blinded to the type of stimulation presented.

Results

Initially, nine patients responded that pulses felt the same when alternating between CV and CC, while four preferred current and one preferred voltage. However, during blinded and randomized pulse trains, the preferences became less clear. Two patients with initial CC and CV preferences, respectively, actually preferred more of the opposite pulse type. Two patients initially choosing CC were not able to consistently identify pulse pairs. Only one patient having a preference at the start (CC) was able to correctly choose CC pulses during the randomized study. Overall, few patients consistently identified when “same” and “different” pulses were being presented. Only three patients performed above average by indicating that at least 6/10 pulses were the same and 7/10 pulses were different. Of these patients, two preferred voltage, while one preferred current.

Conclusion

Few patients displayed a strong preference for either CV or CC. When a preference was initially indicated (5/14), in only one case did the blinded, randomized portion of the study support the patient’s perceived stimulation preference.

Acknowledgements

Contributors include C.M. Schade, D.M. Schultz, J. Greenberg, L.M. Johanek, G.W. King. This study was supported by Medtronic.

Author Addresses

  • Center for Pain Control
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  • 2692 West Walnut Street
  • Garland, Texas 75042
  • MAP Applied Research Center
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  • Edina, MN 55435
  • Medtronic Neuromodulation
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  • Minneapolis MN, 55432