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. 2021 Mar 12;14:721–736. doi: 10.2147/JPR.S297091

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© 2021 Deer et al.

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Remote selective targeting promotes activation of large diameter fibers while avoiding activation of small diameter fibers using PNS systems and open coil leads designed for placement distant to the nerve. Large diameter fibers have lower activation thresholds than smaller diameter fibers, and thresholds also increase with electrode-to-fiber distance. The activation zones are shown for Aα/β fibers (blue) and Aδ/C fibers (orange). (A) For a conventional PNS electrode placed intimate to the nerve, a limited number of Aα/β fibers may be activated. (B) Increasing the intensity to activate a larger proportion of Aα/β fibers begins to concurrently activate Aδ/C fibers or motor fibers, causing unintended discomfort. (C) A system using a percutaneous open-coil electrode placed remotely from the nerve (eg, 0.5–3 cm) is designed to selectively activate a larger proportion of Aα/β fibers without concomitant activation of Aδ/C fibers.