Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

Abstract

The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

An Injectable Neural Stimulation Electrode Made from an In‐Body Curing Polymer/Metal Composite

“…In recent years, the Federal Food and Drug Administration (FDA) has approved market applications for a myriad of new indications for bioelectronic medicines including diverse conditions such as obesity, sleep apnea, migraine, opioid withdrawal symptoms, dry eye, essential tremor, and hypertension. These supplement traditional market indications for bioelectronic medicines such as pain and overactive bladder . Additional areas of research currently beginning early stage clinical testing include the use of therapeutic electrical stimulation to treat inflammation, metabolism, and endocrine disorders .…”

Spinal Cord Stimulation for Refractary Neuropathic Pain and Its Action on the Neurovegetative Systems

“…Related to gastric digestion, bowel and bladder function, 8 of 13 patients improved after SCS implantation (p < 0.05) ( Table 5), and finally, related to adverse effects, one of the patients had electrode migration, in the second patient, there was infection at the site of the generator, and the third patient had to change the percutaneous technique by open surgery, due to obesity. [7,8], as in our study population. Interesting, the population was constituted by mainly white people.…”

On the Right Track to Treat Movement Disorders: Promising Therapeutic Approaches for Parkinson’s and Huntington’s Disease

“…Generally used for the treatment of chronic pain since 1967 (Shealy et al, 1967 ; Dones and Levi, 2018 ), SCS consists of the application of electrical pulses in the dorsal columns of the spinal cord (directly in the epidural space). It has been suggested that the mechanism of action is based on the antidromic activation of the dorsal column fibers, which activate the inhibitory interneurons within the dorsal horn (Yampolsky et al, 2012 ).…”