Are 10 kHz Stimulation and Burst Stimulation Fundamentally the Same?

Background: Spinal cord stimulation (SCS) is routinely used for intractable pain syndromes. For SCS to be efficacious the painful area needs to be covered by SCS induced paresthesia symptoms. Recently, novel stimulation designs have been developed for spinal cord stimulation (SCS) that are superior to classical spinal cord stimulation and exert their effects without the mandatory paresthesia. Two such stimulation designs are burst stimulation and 10 kHz stimulation. Objective: Whereas the mechanism of action of burst SCS has been partly elucidated, in that it modulates the medial pain pathway in contrast to tonic stimulation, the mechanism of action of 10 kHz SCS is still enigmatic. The goal of this paper is to provide a perspective or informed opinion on the differences and similarities between burst SCS and 10 kHz stimulation by using a literature search on the two stimulation designs. Discussion/Conclusion: Human clinical data, simulation studies, quantitative sensory testing, cellular investigations, and comparative animal and human studies all point in the same direction, namely that 10 kHz and burst SCS might both modulate the medial pain pathway, and could be fundamentally similar neurostimulation designs.