A Call to Action Toward Optimizing the Electrical Dose Received by Neural Targets in Spinal Cord Stimulation Therapy for Neuropathic Pain

Krishnan Chakravarthy,1,2 Rajiv Reddy,1 Adnan Al-Kaisy,3 Thomas Yearwood,3 Jay Grider4 1Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA; 2VA San Diego Healthcare System, San Diego, Ca, USA; 3Pain Management and Neuromodulation Centre at Guy’s and St. Thomas’ NHS Trust, London, UK; 4Division of Pain Medicine, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, 40536, USACorrespondence: Krishnan ChakravarthyDepartment of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, 3350 La Jolla Village Drive, San Diego, CA 92161, USATel +1 858-246-2392Email kvchakravarthy@health.ucsd.eduAbstract: Spinal cord stimulation has seen unprecedented growth in new technology in the 50 years since the first subdural implant. As we continue to grow our understanding of spinal cord stimulation and relevant mechanisms of action, novel questions arise as to electrical dosing optimization. Programming adjustment — dose titration — is often a process of trial and error that can be time-consuming and frustrating for both patient and clinician. In this report, we review the current preclinical and clinical knowledge base in order to provide insights that may be helpful in developing more rational approaches to spinal cord stimulation dosing. We also provide key conclusions that may help in directing future research into electrical dosing, given the advent of newer waveforms outside traditional programming parameters.Keywords: neural dosing, pharmacology, neuromodulation, spinal cord stimulation, electrical dosin