High‐Frequency Stimulation of Dorsal Column Axons: Potential Underlying Mechanism of Paresthesia‐Free Neuropathic Pain Relief

Spinal cord stimulation (SCS) treats neuropathic pain through retrograde stimulation of dorsal column axons and their inhibitory effects on wide dynamic range (WDR) neurons. Typical SCS uses frequencies from 50–100 Hz. Newer stimulation paradigms use high‐frequency stimulation (HFS) up to 10 kHz and produce pain relief but without paresthesia. Our hypothesis is that HFS preferentially blocks larger diameter axons (12–15 µm) based on dynamics of ion channel gates and the electric potential gradient seen along the axon, resulting in inhibition of WDR cells without paresthesia.

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