Epidural spinal cord stimulation for treatment of chronic pain—some predictors of success. A 15-year experience

Kumar, Krishna; Toth, Cory; Nath, Rahul K.; Laing, Patricia

doi:10.1016/s0090-3019(98)00012-3

Cited by 291 publications

(223 citation statements)

References 41 publications

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“…Epidural spinal cord stimulation has long been used to treat intractable pain in patients (29,111,116,145,146,149,177,183,188,227,230). Sayenko et al (220) showed that lumbosacral epidural stimulation activated widespread rostral and caudal areas of the lumbar spinal cord, involving afferent and efferent pathways, in a patient with chronic SCI.…”

Section: Epidural Spinal Cord Stimulationmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Section: Epidural Spinal Cord Stimulationmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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“…The positioning of the spinal electrode should be precise in order to allow for overlap of the pain area during trial stimulation. This fact has been shown to be important for long-term efficacy of spinal cord stimulation (SCS) 24,25 . The SCS appears to be most effective in patients with impartial and postcordotomy pain 5 .…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Neuropathic pain in patients with spinal cord injury: report of 213 patients

Teixeira

Paiva²,

Assis³

et al. 2013

Arq. Neuro-Psiquiatr.

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Objective: Management of neuropathic pain following spinal cord injury (SCI) can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury.Methods: In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. Results: The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection. Complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Conclusions: Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.Key words: spinal cord injury, neuropathic, pain, treatment. RESUMOObjetivo: Tratamento de dor neuropática após lesão da medula espinhal (LM) representa um desafio terapêutico.e pode ser uma experiên-cia frustrante para os pacientes. Os autores descrevem as características clínicas de um grupo de pacientes tratados com dor após lesão medular. Método: Foram avaliados retrospectivamente 213 pacientes com LM e dor neuropática. Em relação a características clínicas, opções de tratamento e intensidade da dor nestes pacientes. Resultados: A principal causa foi traumatismo raquimedular, que ocorreu em 169 pacientes, seguida por tumores e infecções. Lesões completas foram verificadas em 144 pacientes. Em nosso estudo, os pacientes com traumatismos e lesões parciais apresentaram dor aparentementemais intensa, no entanto, sem diferença estatisticamente significativa.Conclusão: A dor neuropática é uma queixa comum em pacientes com LM e apresenta um desafio para equipe de tratamento. Conhecimento das características clínicas deste grupo de pacientes pode ajudar a determinar a melhor abordagem para intervenção terapêutica.Palavras-Chave: dor neuropática, lesão medular, tratamento.

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“…Cerebrospinal Stimulation and Low-dose Ketamine Drip Infusion Therapy for the Treatment of Neuropathic Pain Takamitsu YAMAMOTO 1) , Koichiro SUMI 2) , Toshiki OBUCHI 2) , Minoru OTAKA 2) , Toshikazu KANO 2) , Kazutaka KOBAYASHI 2) , Hideki OSHIMA 3) , Chikashi FUKAYA 1) and Yoichi KATAYAMA Table 1 ketamine-resistant ketamine-resistant 20% ketamine-sensitive 5.4% ketaminesensitive 9) ketamine-sensitive 100 ml 20 mg ® (0.33 mg/Kg) 1 2 (Ludiomil®) 10 30 mg/day (Lexotan®) 2 6 mg/day (GABAPEN®) 600 2400 mg/day 10,11) morphine-sensitive MS ® 30 mg/day ( ketamine-sensitive II.…”

Section: )mentioning

confidence: 99%

Cerebrospinal Stimulation and Low-dose Ketamine Drip Infusion Therapy for the Treatment of Neuropathic Pain

Yamamoto¹,

Sumi²,

Obuchi³

et al. 2010

Nichidai Igaku Zasshi

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For the treatment of intractable neuropathic pain, drug challenge test is necessary and useful to examine the pharmacological background of the pain in each case. Based on the results of drug challenge test, we can select the candidates for low-dose ketamine drip infusion (LDKDI) therapy and cerebrospinal stimulation therapy. In cerebrospinal stimulation therapy, dual-lead spinal cord stimulation should be selected at first, since we can insert electrodes percutaneously and this is suitable for both the test stimulation and chronic implantation. For the treatment of peripheral deafferentation pain, which includes phantom limb pain and peripheral nerve injury pain, deep brain stimulation therapy of the thalamic relay nucleus is suitable. Motor cortex stimulation therapy is suitable for the treatment of central deafferentation pain, which includes post-stroke pain. LDKDI therapy combined with cerebrospinal stimulation therapy achieves remarkable pain reduction in the treatment of neuropathic pain.

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Epidural spinal cord stimulation for treatment of chronic pain—some predictors of success. A 15-year experience

Cited by 291 publications

References 41 publications

Electrical Stimulation and Motor Recovery

Electrical Stimulation and Motor Recovery

Neuropathic pain in patients with spinal cord injury: report of 213 patients

Cerebrospinal Stimulation and Low-dose Ketamine Drip Infusion Therapy for the Treatment of Neuropathic Pain

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