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Abstract
BACKGROUND: Peripheral nerve field stimulation (PNFS) is a potential treatment for chronic low-back pain. Pain relief using PNFS is dependent on activation of non-nociceptive Aβ-fibers. However, PNFS may also activate muscles, causing twitches and discomfort. In this study, we developed a mathematical model, to investigate the activation of sensory and motor nerves, as well as direct muscle fiber activation.
METHODS: The extracellular field was estimated using a finite element model based on the geometry of CT scanned lumbar vertebrae. The electrode was modeled as being implanted to a depth of 10-15 mm. Three implant directions were modeled; horizontally, vertically, and diagonally. Both single electrode and "between-lead" stimulation between contralateral electrodes were modeled. The extracellular field was combined with models of sensory Aβ-nerves, motor neurons and muscle fibers to estimate their activation thresholds.
RESULTS: The model showed that sensory Aβ fibers could be activated with thresholds down to 0.563 V, and the lowest threshold for motor nerve activation was 7.19 V using between-lead stimulation with the cathode located closest to the nerves. All thresholds for direct muscle activation were above 500 V.
CONCLUSIONS: The results suggest that direct muscle activation does not occur during PNFS, and concomitant motor and sensory nerve fiber activation are only likely to occur when using between-lead configuration. Thus, it may be relevant to investigate the location of the innervation zone of the low-back muscles prior to electrode implantation to avoid muscle activation.
Original language | English |
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Journal | Neuromodulation: Technology at the Neural Interface |
Volume | 19 |
Issue number | 6 |
Pages (from-to) | 587-596 |
ISSN | 1094-7159 |
DOIs | |
Publication status | Published - 2016 |
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Dive into the research topics of 'Muscle activation during peripheral nerve field stimulation occurs due to recruitment of efferent nerve fibers, not direct muscle activation'. Together they form a unique fingerprint.Projects
- 1 Finished
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Modeling the effects of repeated non-square waveforms for subcutaneous and intracutaneous stimulation for pain relief
01/08/2013 → 31/07/2017
Project: Research