earticle

영어

Chronic back pain is a prevalent condition often refractory to conventional medical therapies, prompting the use of spinal cord stimulation (SCS) for intractable cases such as chronic pain after spinal surgery. Traditional SCS, however, demonstrates limitations, including inconsistent relief for axial back pain and potential loss of efficacy over time. This narrative review synthesizes the conceptual foundations, neurophysiological mechanisms, and emerging clinical evidence supporting differential target multiplexed (DTM) SCS in chronic back pain management. DTM SCS employs multiplexed electrical stimulation, integrating a low-frequency base signal with multiple high-frequency prime signals to concurrently target neurons and glial cells—whose dysregulated interplay drives chronic pain persistence and neuroinflammation—unlike conventional SCS, which predominantly modulates neuronal activity. Preclinical investigations reveal DTM’s superiority over traditional and high-frequency SCS in altering neural cell-specific transcriptomes and enhancing mechanical withdrawal thresholds in neuropathic pain models. Clinically, DTM SCS yields substantially greater therapeutic efficacy, offering a promising advancement for refractory back pain.