Spinal cord stimulation in chronic pain: technical advances

Abstract

Chronic severe pain results in a detrimental effect on the patient's quality of life. Such patients have to take a large number of medications, including opioids, often without satisfactory effect, sometimes leading to medication abuse and the pain worsening. Spinal cord stimulation (SCS) is one of the most effective technologies that, unlike other interventional pain treatment methods, achieves long-term results in patients suffering from chronic neuropathic pain. The first described mode of SCS was a conventional tonic stimulation, but now the novel modalities (high-frequency and burst), techniques (dorsal root ganglia stimulations), and technical development (wireless and implantable pulse generator-free systems) of SCS are becoming more popular. The improvement of SCS systems, their miniaturization, and the appearance of new mechanisms for anchoring electrodes results in a significant reduction in the rate of complications and revision surgeries, and the appearance of new waves of stimulation allows not only to avoid the phenomenon of addiction, but also to improve the long-term results of chronic SCS. The purpose of this review is to describe the current condition of SCS and up-to-date technical advances.

Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

“…Both tonic and burst modes effectively deliver waveforms to the lateral and descending pathways, but the medial pathway is better stimulated by burst waveforms. 16 , 26 In addition, burst waveforms more effectively activate the cerebral cortex than tonic waveforms, 16 , 27 which might also support the outcomes in these current two cases.…”

Complex Regional Pain Syndrome: A Comprehensive Review

“…Several options have been used as surgical treatment for CRPS in effort to avoid excessive use of opioids and improve quality of life. One such therapy is spinal cord stimulation, which has been used for over 50 years as the most common treatment for chronic pain globally [ 100 ]. This approach traditionally involves tonic electrical stimulation of the dorsal columns avoiding ablation and in theory utilizing the ‘gate-control’ theory of Melzack and Wall [ 100 , 101 ].…”

An Italian Expert Consensus on the Use of Opioids for the Management of Chronic Non-Oncological Pain in Clinical Practice: Focus on Buprenorphine.

“…50,51 About the statements regarding interventional therapy, a large consensus was reached about the midterm efficacy of epidural steroids for radicular pain and the long-term results of Spinal Cord Stimulation for the treatment of Complex regional Pain Syndromes and Failed Back Pain Syndromes (statements 30, 33), according to the latest evidence in the literature. [52][53][54] Instead, no consensus was reached on the utility of adding O 2 O 3 to steroids and local anestethics at the transforaminal level (statement 31).…”