Does high-frequency stimulation of sensory axons break the causal link between pain relief and paresthesia?

Neurostimulation produces unnatural cutaneous sensations with potent analgesic effects in pain syndromes. In this issue of Neuron, Sagalajev et al. 1 Sagalajev B. Zhang T. Abdollahi N. Yousefpour N. Medlock L. Al-Basha D. Ribeiro-da-Silva A. Esteller R. Ratté S. Prescott S.A. Absence of paresthesia during high-rate spinal cord stimulation reveals importance of synchrony for sensations evoked by electrical stimulation. Neuron. 2023; 112: 404-420https://doi.org/10.1016/j.neuron.2023.10.021 Abstract Full Text Full Text PDF Scopus (0) Google Scholar demonstrate that these sensations are an epiphenomenon and explain how high-frequency stimulation can provide analgesia without these unnecessary sensations. Neurostimulation produces unnatural cutaneous sensations with potent analgesic effects in pain syndromes. In this issue of Neuron, Sagalajev et al. 1 Sagalajev B. Zhang T. Abdollahi N. Yousefpour N. Medlock L. Al-Basha D. Ribeiro-da-Silva A. Esteller R. Ratté S. Prescott S.A. Absence of paresthesia during high-rate spinal cord stimulation reveals importance of synchrony for sensations evoked by electrical stimulation. Neuron. 2023; 112: 404-420https://doi.org/10.1016/j.neuron.2023.10.021 Abstract Full Text Full Text PDF Scopus (0) Google Scholar demonstrate that these sensations are an epiphenomenon and explain how high-frequency stimulation can provide analgesia without these unnecessary sensations. Absence of paresthesia during high-rate spinal cord stimulation reveals importance of synchrony for sensations evoked by electrical stimulationSagalajev et al.NeuronNovember 15, 2023In BriefElectrically stimulating somatosensory afferents at high frequency does not evoke paresthesia. Sagalajev et al. show that spikes desynchronize when axons are stimulated faster than their refractory period. Spikes engage inhibition regardless of their synchrony, but asynchronous spikes are preferentially blocked by inhibition and thus fail to activate cortex and cause paresthesia. Full-Text PDF