Table 1.

Summary of stimulation paradigms.

Stimulation Paradigm	Mechanism (Altered Parameter)	Benefit
High Frequency Stimulation	High frequency of stimulation ranging from 1–10 kHz with amplitudes below the sensory threshold	No parasthesia at target sites [30], greater decrease in mean back pain score compared to cSCS [17], sustained pain relief up to three years after implant [35]
Burst Stimulation	High frequency stimulation period followed by rest phase thought to mimic natural neuronal firing pattern [36]	Notable improvement in back, limb and general pain compared to cSCS [40], superior to HF–SCS in reducing leg pain [41,42], positive effects on mood [40,43,44]
Intermittent Dosing Burst Stimulation	Duty cycle alteration (amount of time burst stimulation is active and inactive)	No difference in pain relief or quality of life compared to burst [45], increasing time to habituation due to overall decrease in time nerve is stimulated [45], decreased energy consumption of system [45], increased customizability to patient preference [46]
Closed Loop System	Constant measure and response to changing electrophysiological and postural changes (ie more efficacious stimulation to target) [51]	Greater pain relief as compared to open-loop systems from three months to two years [48,50], improvement in patient quality of life, emotional functioning and reduciton in opiate use at two years [51,53]
Stimulation Holidays	Discontinue stimulation for a period of time before restarting, thought to reset receptor mediate pathways and re-establish sensitivity [74,75,76]	Approximatley 20 day holiday can lead to significant, sustained pain relief 6 months later [61]