Spinal cord stimulation for the treatment of chronic non-malignant pain

Abstract

SummaryOver the past four decades, techniques and devices for spinal cord stimulation have undergone considerable refinement. Currently, percutaneous implantable electrodes are placed in the epidural space and a low-frequency electrical current is used to modify the transmission of chronic pain signals in the dorsal columns of the spinal cord.Before permanent implantation, the spinal cord stimulation will be examined during a test phase to determine its analgesic effect and tolerability.We have reviewed our experience in 88 patients with chronic nonmalignant pain. The follow-up of our study ranged from 15 to 75 months, with an average of 60 months.The indication for SCS in these 88 patients was mainly neuropathic pain syndromes.The patients were followed up by the Visual Analog Scale (VAS), level of activity and subjective assessment of the quality of life. On the basis of the patients' self-assessments using the VAS, the degree of pain relief was excellent=good in 72 of 88 patients (82%). At the end of the follow-up period, 50% of the patients were in a better psychological status and 86% of the patients reported an improvement in activities of their daily living and a reduction in the use of analgesic medication. Ninety percent of the patients stated that they would go through the procedure again for the same result.The findings of the present study indicate that spinal cord stimulation is an efficacious therapy for the treatment of chronic non-malignant pain.

Dorsal column stimulator applications

“…A psychiatric evaluation should be done before the procedure is performed. [3187383] It is thought that the dorsal column fibers should retain at least some degree of functional integrity, to produce some inhibitory effect on the pain transmitting system, which is consistent with some findings of a lack of efficacy in patients with neuropathic pain, in whom the lesion is located proximal to the dorsal root ganglion, leading to extreme hypesthesia in the painful area. It would be due to orthodromic degeneration of the primary fibers emanating from the lesion up to the brainstem.…”

“…Probably, the physiological bases of pain relief are different, depending on its cause. [518183102] Most experimental data regarding this topic are derived from animal models of neuropathic pain, in which pain must be evaluated in an indirect manner. As pain cannot be properly assessed and interpreted in animals, hypersensitivity after a nerve injury is the most common indirect behavioral sign of pain used in animal models.…”

“…Due to its reversibility and safety, neuromodulative approaches are preferred over neuroablative procedures, which have been more commonly performed in the previous era. [3342727383108129161]…”

“…It represented the first scientific basis for the use of electrical stimulation for pain. [337383100108129161] In 1967, Wall and Sweet started to use peripheral nerve stimulation to treat pain. Based on this theory, Shealy et al .…”

“…However, it is possible to introduce a paddle-type one by using a tubular retractor system under local anesthesia. [61423425166738183108127134145161] At present, the indications of SCS are being revised constantly, while new applications are being proposed and researched worldwide. Spinal cord stimulation is the most frequently applied neuromodulation method.…”