Differential target multiplexed SCS (DTM SCS): a rational hypothesis

Background Early in the development of technology for spinal cord stimulation (SCS) therapy, the challenge of treating chronic low back pain was met with specific electrode configurations and programming parameters designed to target and maintain paresthesia in that region. New modalities were subsequently developed to achieve long-term relief of chronic low back and leg pain and minimize unwanted stimulation. Only recently has it become clear that SCS mechanisms for modulating pain involve not only the activation of Aβ-fibers but also other mechanisms, such as the modulation of biological processes at the glial cells and neuroglial interaction. Content overview Differential Target MultiplexedTM (DTMTM) programming, a combination of multiplexed pulsed signals delivered synchronously at different rates and amplitudes, was shown in animal models to revert neurons and glia in the stimulated spinal cord from an injured state back to a noninjured state in transcriptomics and proteomics studies. This article highlights the rationale for and development of DTM SCS and provides an overview of its clinical application. We review key outcomes of pivotal DTM SCS studies within the context of other randomized clinical trials (RCTs) examining SCS for the treatment of chronic low back pain. Conclusions The development of DTM SCS is based on preclinical research, parameter refinement in a feasibility study, and confirmatory RCTs showing promise in enhancing outcomes of patients with chronic low back pain.