Spinal Cord Stimulation in Pain Management: A Review

Abstract

Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.

Spinal Cord Stimulation: A Dominant Therapy for Refractory Angina Pectoris

“…Patient may have different electrocardiographic changes during angina involving multiple leads or a few leads, troponin I may have positive or negative, left ventricular function may be normal or abnormal and coronary pathology varies tremendously in the extent. One can be suspicious that a patient may be potentially refractory and have a poor prognosis if biochemical markers such as troponin T or I are elevated and also if C-reactive protein levels are elevated 4 .…”

Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

“…During the selection, different factors have been considered, such as the etiology of pain, type and localization of pain, age of the patient, and the radiological and neurological findings summarized in Table 1 (20)(21)(22)28,30,31,(37)(38)(39)(40)(41)(42)(43)(44).…”

“…• Patients with medical intractability of neuropathic pain (20,22,26,32,38,(45)(46)(47)(48)(49) During the surgical procedure of trial implantation, patients should be asked to indicate the location of parenthesis (change of sensibility correlated to the spinal segment stimulated) since it is relevant to confirm that the resultant parenthesis overlaps with the painful area to achieve good analgesia (20)(21)(22)26,28,45).…”

“…Painful symptoms are controlled through the spinal electrical stimulation, using epidural electrode placed in the posterior horn of the spinal cord (13,15,16,22,(26)(27)(28). SCS was firstly described by Shealy et al (29), in 1967, as an alternative for ablative neurosurgical procedures in the management of refractory pain.…”

Advances in Spinal Cord Stimulation for Treatment of Chronic Pain

“…Current proposed mechanisms include inhibition of the excitatory neurotransmitters in the central nervous system through activation of caminobutyric acid (GABA-B) receptors as well as alteration of the hyperactivity of the sympathetic nervous system via adenosine receptors [7 •• ], which could account for the effectiveness of SCS in the treatment of angina. Regardless of the lack of concrete evidence for the SCS mechanism of action, Ramasubbu et al [8] promoted the field of SCS research by proposing in 2013 that a more thorough understanding of the principles of electrical stimulation and dorsal column mapping will greatly improve the accuracy of lead placement and manipulation of electrical parameters, thereby improving the outcomes associated with suboptimal paresthesia coverage.…”