Low-Frequency, Weak Extradural Stimulation in the Management of Intractable Pain

Shimoji, Koki; Matsuki, Michiko; Shimizu, Hiroyuki; Iwane, Tadashi; Takahashi, Ryuichi; Maruyama, Michiro; Masuko, K

doi:10.1093/bja/49.11.1081

Cited by 20 publications

(15 citation statements)

References 22 publications

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“…Anatomical studies have provided evidence that a subset of fine myelinated and unmyelinated fibres enter the dorsal column and terminate in the SG (Horch, Burgess & Whitehorn, 1976;Sugiura et al 1989). Clinical observations show that dorsal column stimulation is a useful method for pain relief (Nashhold & Friedmann, 1972;Shimoji et al 1977). It would be expected that there is a mechanism in the SG that allows activity in myelinated fibres in the dorsal column to produce an inhibition of the responses of dorsal horn neurones to noxious stimuli.…”

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confidence: 99%

Synaptic responses of substantia gelatinosa neurones to dorsal column stimulation in rat spinal cord in vitro.

Baba¹,

Yoshimura²,

Nishi³

et al. 1994

The Journal of Physiology

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1. To study the mechanism of dorsal column stimulation-induced depression of nociceptive transmission in the spinal cord, synaptic responses evoked in dorsal horn neurones by dorsal column and dorsal root stimulations were examined in a horizontal spinal cord slice of the adult rat. Intracellular recordings were made from substantia gelatinosa (SG) neurones. 2. All SG neurones examined received monosynaptic inputs and/or polysynaptic inputs from both dorsal column and dorsal root. Ad fibres were probably responsible for the synaptic responses. The responses evoked by dorsal column stimulation were similar to those evoked by primary afferent Ad fibre stimulation. 3. Monosynaptic excitatory postsynaptic potentials (EPSPs) evoked by dorsal column Ad fibres were depressed by 6-cyano-7-nitroquinoxaline-2,3-dione, suggesting that these fibres released L-glutamate or a related amino acid as a transmitter. 4. In 38 of 101 SG neurones, dorsal column stimulation evoked an initial EPSP followed by fast and/or slow inhibitory postsynaptic potentials (IPSPs). These IPSPs reversed polarity at a membrane potential of -73 + 2 mV. The fast IPSPs observed in 16 of the SG neurones (42 %) that received inhibitory inputs were depressed by strychnine, while the slow IPSPs observed in 22 SG neurones were depressed by bicuculline. In a few cells, a long-lasting slow IPSP with a much slower time course was detected; this IPSP was insensitive to strychnine and bicuculline, and reversed polarity at a membrane potential near -90 mV. 5. Repetitive stimulation of the dorsal column depressed the amplitude of monosynaptic EPSPs evoked by dorsal root stimulation. 6. The responses of SG neurones to dorsal column stimulation had configurations and durations similar to responses to dorsal root stimulation, and may be mediated largely by the same Ad fibres. However, a C fibre-mediated response could not be detected in SG neurones from dorsal column stimulation, although dorsal root stimulation could evoke C fibre-mediated monosynaptic EPSPs in 18 of 88 SG neurones (20 %). 7. These observations suggest that SG neurones receive abundant AS but not C fibre inputs from the dorsal column and that dorsal column stimulation inhibits primary afferent transmission in the spinal cord both by reducing transmitter release from primary Ad fibres and by hyperpolarizing SG neurones.Many fine afferent fibres that carry nociceptive information fibre classes and to modify the output of projection neurones terminate in the superficial dorsal horn of the spinal cord, located in lamina I and in deeper regions of the dorsal horn particularly in the substantia gelatinosa (SG, lamina II of (Kumazawa & Perl, 1978;Light, Trevino & Perl, 1979). Rexed) (Rexed, 1952;Maxwell & Rethelyi, 1987; Sugiura, Melzack & Wall (1965) proposed the gate control theory for Terui & Hosoya, 1989;Yoshimura & Jessell, 1989a. the dorsal horn circuitry responsible for pain transmission. SG neurones form local interneuronal circuits that are In their model, SG inhibitory neurones, activated by la...

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confidence: 99%

Synaptic responses of substantia gelatinosa neurones to dorsal column stimulation in rat spinal cord in vitro.

Baba¹,

Yoshimura²,

Nishi³

et al. 1994

The Journal of Physiology

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“…2). The inhibitory effect of DCS on sensory information, including pain, has been well documented, although the site and mode of its action have raised several controversial hypotheses (1)(2)(3)(4)(5)(6)16). This study did not attempt to deal with this mechanism but, rather, with the effects of isoflurane and supraspinal structures on the inhibition by DCS of the segSCP.…”

Section: Discussionmentioning

confidence: 99%

“…( (1)(2)(3)(4)(5)(6). However, the segmental and supraspinal mechanisms of the modulatory actions of DCS have not been investigated (3,5,7).…”

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confidence: 99%

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The Effects of Isoflurane on Conditioned Inhibition by Dorsal Column Stimulation

Tobita

Okamoto²,

Shimizu³

et al. 2003

Anesthesia & Analgesia

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“…This includes electrode fracture, faulty pulse generators and radiofrequency receivers, extension cable breakage, and "leaky" connectors [33,35,36,[38][39][40]. These complications are easily treated by replacement of the problematic component.…”

Section: Complicationsmentioning

confidence: 99%

Neuromodulation: Spinal cord and peripheral nerve stimulation

Day

2000

Current Review of Pain

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Spinal cord and peripheral nerve stimulation for relief of chronic intractable pain have been used since the mid-1960s. Multiple mechanisms of action have been theorized without a clear-cut winner. The early frustrations with patient selection criteria and equipment difficulties have diminished secondary to carefully controlled studies and improvements in equipment designs. Efficacy studies consistently show an overall 50% improvement in long-term pain control in patients who have failed conservative or other invasive modalities. With improvements in today's technology, one hopes that better analgesia will be attainable.

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Low-Frequency, Weak Extradural Stimulation in the Management of Intractable Pain

Cited by 20 publications

References 22 publications

Synaptic responses of substantia gelatinosa neurones to dorsal column stimulation in rat spinal cord in vitro.

Synaptic responses of substantia gelatinosa neurones to dorsal column stimulation in rat spinal cord in vitro.

The Effects of Isoflurane on Conditioned Inhibition by Dorsal Column Stimulation

Neuromodulation: Spinal cord and peripheral nerve stimulation

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