Since 1967, spinal cord stimulation (SCS) has been used to manage chronic intractable pain of the trunk and limbs. Compared to traditional high-intensity, low-frequency (<100 Hz) SCS that is thought to produce paresthesia and pain relief by stimulating large myelinated fibers in the dorsal column (DC), low-intensity, high-frequency (10 kHz) SCS has demonstrated long-term pain relief without generation of paresthesia. To understand this paresthesia-free analgesic mechanism of 10 kHz SCS, we examined whether 10 kHz SCS at intensities below sensory thresholds would modulate spinal dorsal horn (DH) neuronal function in a neuron type-dependent manner. By using in vivo and ex vivo electrophysiological approaches, we found that low-intensity (sub-sensory threshold) 10 kHz SCS, but not 1 kHz or 5 kHz SCS, selectively activates inhibitory interneurons in the spinal DH. This study suggests that low-intensity 10 kHz SCS may inhibit pain sensory processing in the spinal DH by activating inhibitory interneurons without activating DC fibers, resulting in paresthesia-free pain relief.

中文翻译：

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低强度，千赫兹频率的脊髓刺激以不同的方式影响啮齿动物浅表背角的兴奋性和抑制性神经元。

自1967年以来，脊髓刺激（SCS）已用于处理躯干和四肢的慢性顽固性疼痛。与传统的高强度，低频（<100 Hz）SCS相比，后者被认为可以通过刺激背柱（DC）中的大型髓鞘纤维来产生感觉异常和疼痛缓解，而低强度，高频（10 kHz）SCS已显示出长期的疼痛缓解感，而不会产生感觉异常。为了解这种10 kHz SCS的无感觉异常镇痛机制，我们检查了低于感觉阈值强度的10 kHz SCS是否会以神经元类型依赖性方式调节脊髓背角（DH）神经元功能。通过使用体内和体外电生理学方法，我们发现低强度（亚感觉阈值）10 kHz SCS，而不是1 kHz或5 kHz SCS，选择性激活脊髓DH中的抑制性神经元。这项研究表明，低强度的10 kHz SCS可能通过激活抑制性神经元而不激活DC纤维来抑制脊髓DH的疼痛感觉过程，从而导致无感觉异常的疼痛缓解。