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. 2025 Jun 17:6:1606672.
doi: 10.3389/fpain.2025.1606672. eCollection 2025.

Low-intensity focused ultrasound of the spine in the treatment of chronic pain and movement disorder: a scoping review

Kyung Seol  1 , Brian Hong  1 , Nicolas Kelhofer  1 , Suguna Pappu  1   2 , Michael Oelze  3   4   5
Affiliations

Low-intensity focused ultrasound of the spine in the treatment of chronic pain and movement disorder: a scoping review

Kyung Seol et al. Front Pain Res (Lausanne). .

Abstract

Low-Intensity Focused Ultrasound Stimulation (LIFU) is a noninvasive and nondestructive neuromodulatory method with growing evidence for the safe and effective treatment of chronic pain. However, the effect of LIFU applied to the spine region, including the spinal cord and dorsal root ganglia, is not well understood. In this work, we review current advances in LIFU of the spine region for the treatment of chronic neuropathic pain and movement disorders to explore potential clinical applications and indicate a direction for future study. To assess the current state of LIFU application to pain modulation over the spinal cord region, a systematic search was performed according to PRISMA guidelines using PubMed, Web of Science, Scopus, and citation matching through December 17, 2024. Inclusion criteria were English language, non-tissue-damaging ultrasound neuromodulation, intervention over the spinal cord region, and relation to neuropathic pain. Exclusion criteria were existing review papers, extracorporeal shockwave therapy, tissue-destructive ultrasound treatments, non-focused ultrasound, and in vitro experiments. Preliminarily, title and abstract screening identified 15 studies, all using animal models. While results varied with different target sites and ultrasound parameters, LIFU was found to reduce allodynic response and suppress movement disorders such as spasticity and tremor. There are limited animal studies and no completed human clinical trials that analyze the effect of LIFU on spinal neural tissue. Further, there has not been a study that aims to optimize ultrasound parameters in the spine region or a thorough investigation correlating targets in the spinal regions to the desired outcome. We reviewed the current understanding of LIFU of the spine region for treating chronic pain, spasticity, and tremors to identify current advances and gaps in the literature. Our review highlights the need for further study in the efficacy and safety of LIFU applied to the spinal region of animals and humans, given the wide variation in sonication parameters, inconsistent treatment effects, and unexplored mechanisms of action.

Keywords: chronic neuropathic pain; dorsal root ganglia (DRG); focused ultrasound (FUS); low intensity focused ultrasound (LIFU); movement disorders; neuromodulation; noninvasive pain treatment; spinal cord.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Diagram illustrating an ultrasound stimulation structure. The top panel shows total sonication period (TSP) and sonication duration (SD) with an inter-sonication interval (ISI). The bottom panel displays a sonication parameter labeled with pulse width (PW), pulse repetition frequency (PRF), and frequency.
Figure 1
Ultrasound parameters and pulsing regime are visualized. ISI, inter-sonication interval; TSP, total sonication period; SD, sonication duration; PW, pulse width; PRF, pulse repetition frequency. Duty cycle (DC) is the product of pulse width and PRF. When DC is 1, FUS is applied continuously within the sonication duration. DC in this context is exclusively used to characterize parameters within the sonication parameters. Created with BioRender.com.
Graph illustrates temporal and spatial characteristics of sonication. Red waveform peaks represent sonication pulses. The time intervals are marked from A to D. Key labels include pulse width (PW, time from A to B or C to D), pulse repetition period (PRP, time from B to D), pulse average intensity (IPA, average of time from A to B), and temporal average intensity (ITA, average of time from B to D). A shaded circular inset shows a spatial representation of stimulation with ISP indicating peak sonication intensity at the center.
Figure 2
Pulse width (PW, time from A to B or C to D) and pulse repetition period (PRP, time from B to D) is shown. ISPTA is calculated as the temporal average intensity (ITA) at the region of Spatial-peak intensity (ISP). ISPTA is used to determine thermal safety profile of FUS. ISPPA is calculated as the pulse average intensity (IPA) at the region of spatial-peak intensity (ISP) on the ultrasound intensity map. Note that ITA is always lower than IPA because ITA includes intensities when resting between time B and C. Created with BioRender.com.
Flowchart summarizing a systematic review process. From 1,538 records identified across Scopus, PubMed, and Web of Science, 964 duplicates were removed. Of 574 records screened by title and abstract, 537 were excluded. Thirty-seven reports were assessed for eligibility, with 22 excluded for reasons including being review papers (n = 7), not related to neuromodulation (n = 3), not using LIFU (n = 1), in vitro models (n = 1), LIFU not targeting the spinal cord (n = 9), and irrelevant pathology (n = 1). Fifteen studies were ultimately included in the review.
Figure 3
Flowchart of search, screening, and study inclusion.
See this image and copyright information in PMC

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