Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Paresthesia Threshold

What determines the perception threshold of stimulation paresthesia?

  • Perception threshold increases with increasing distance of the electrode from the spinal cord, i.e., with increasing depth of dorsal cerebrospinal fluid and with increasing distance of the electrode from the dura.
  • The mediolateral position of the electrode in the spinal canal relative to the physiologic midline influences the perception threshold (which is significantly reduced by lateral asymmetry of less than 1 mm).
  • The distance between contacts
  • The size and orientation of the fibers stimulated
Strength of recommendation Evidence source(s)/rationale
A = Recommended or required
Valid, useful, or non-negotiable		 Computer modeling studies

Holsheimer J, Wesselink WA. Optimum electrode geometry for spinal cord stimulation: the narrow bipole and tripole. Med Biol Eng Comput 35(5):493-497, 1997.
Abstract | Wikistim Entry

Holsheimer J, Barolat G, Struijk JJ, He J. Significance of the spinal cord position in spinal cord stimulation. Acta Neurochir Suppl 64:119-124, 1995.
Abstract | Wikistim Entry

Holsheimer J, Struijk JJ. How do geometric factors influence epidural spinal cord stimulation? A quantitative analysis by computer modeling. Stereotact Funct Neurosurg 56(4):234-249, 1991.
Abstract

Holsheimer J, Khan YN, Raza SS, Khan EA. Effects of electrode positioning on perception threshold and paresthesia coverage in spinal cord stimulation. Neuromodulation 10(1):34-41, 2007.
Abstract | Wikistim Entry

He J, Barolat G, Holsheimer J, Struijk JJ. Perception threshold and electrode position for spinal cord stimulation. Pain 59(1):55-63, 1994.
Abstract | Wikistim Entry