🧘 Spinal Cord Stimulator Waveform Comparison Simulator

Tonic Stimulation — Continuous Paresthesia Coverage

Steady low-frequency pulses replace pain with a tingling sensation.

• 40–60 Hz: Typical frequency (clinical range)
• 200–450 µs: Pulse width (typical setting)
• Overlap: Coverage requirement (must match pain area)
• 1967: First SCS implant (Shealy et al.)

Pulse pattern

Continuous pulses fire steadily at low frequency.

Paresthesia sensation

Patients feel tingling replacing their original pain.

Coverage mapping

Paresthesia must physically overlap the painful area.

Burst Stimulation — Clustered Pulse Trains

Tight pulse clusters mimic natural firing and reduce tingling.

• 40 Hz: Burst rate (bursts per second)
• 5: Pulses per burst (at 500 Hz intraburst)
• ~70%: Paresthesia-free (of treated patients)
• 2016: FDA clearance (burst waveform)

Burst pattern

Five pulses cluster together, mimicking natural neuron firing.

Reduced paresthesia

Most patients feel little or no tingling sensation.

Thalamocortical theory

Bursts modulate attention and affective pain pathways.

High-Frequency (10kHz) Stimulation — Paresthesia-Free

Ultra-fast pulses relieve pain with no sensation at all.

• 10,000 Hz: Frequency (kilohertz range)
• 30 µs: Pulse width (ultra-short pulses)
• >90%: Paresthesia-free (of treated patients)
• 2015: FDA clearance (Senza system)

Ultra-high frequency

10,000 pulses per second exceed sensory nerve response.

Subperception therapy

Patients feel nothing yet report meaningful pain relief.

Dorsal horn quieting

High frequency may block nerve signal conduction directly.

Mechanism Comparison — Three Distinct Pathways

Each waveform likely engages a different pain-blocking circuit.

• 1965: Gate control theory (Melzack & Wall)
• Lamina I–V: Dorsal horn target (sensory relay zone)
• Brainstem: Descending inhibition (top-down pathway)
• A-beta: Fiber activated (large myelinated fibers)

Gate control pathway

Tonic stimulation closes the pain gate directly.

Descending inhibition pathway

High frequency engages brainstem-driven pain suppression circuits.

Dorsal horn modulation

Burst pacing alters neuron excitability without generating sensation.

Waveform Selection — Matching Patient to Pattern

Trial periods let patients compare waveforms before permanent choice.

• 3: Waveform options (tonic · burst · 10kHz)
• 5–7 days: Trial period (before permanent implant)
• 50–70%: Responder rate (across all waveforms)
• As needed: Reprogramming visits (post-implant tuning)

Patient preference

Some patients want to feel stimulation; others don't.

Pain type match

Neuropathic pain often responds differently across waveform types.

Trial-based selection

Short trials let patients compare waveforms before committing.