The Use of Spinal Cord Stimulation in Pain Management

Abstract

SUMMARY Pain is a complex behavior process, the anatomy and physiology of which is not completely understood, and is subject to continuous exploration and research. Following on the heels of Melzack and Wall's gate control theory of pain (1965), Shealey et al., in 1967, were the first to implant stimulation electrodes over the dorsal columns in an attempt to provide relief for patients with chronic, intractable pain. Since then, significant strides in both the technological and therapeutic sides have facilitated the evolution of spinal cord stimulation (SCS) in the management of a variety of pain pathologies. High-quality evidence attests to the efficacy and cost-effectiveness of this modality. In contrast to conventional medical management, SCS offers long-lasting symptom relief, improved quality of life and functional capability, often achieving these goals at a reduced cost. This article illustrates the present status, challenges and future of SCS.

Failed back surgery syndrome: a suggested algorithm of care

“…Not all patients are suitable for the PMP, and patients with unrealistic goals have been shown to have a poor outcome following PMP treatment. [42][43][44] These patients can be very difficult to manage and should be managed by conservative means by close collaboration between GPs and pain clinics, using containment strategies. Some patients can become suitable for PMP therapy with individual psychological and/or physiotherapy treatment sessions.…”

Burst Spinal Cord Stimulation in Peripherally Injured Chronic Neuropathic Rats: A Delayed Effect

“…Over the past 4 decades, spinal cord stimulation (SCS) has become a safe and effective therapeutic tool for the treatment of various chronic pain conditions . Conventional (Con), or tonic, SCS has proven to be effective for the management of various selected chronic neuropathic pain conditions (which are often refractory to pharmacological tools), such as failed back surgery syndrome and complex regional pain syndrome . Con SCS administers continuous pulses of electrical stimulation to the dorsal columns of the spinal cord with frequencies within the range of 40 to 60 Hz .…”

“…The SCS effect emerges from electrodes implanted in the epidural space between the spinal cord and the vertebral column. Despite the positive outcome, the reported success rate of Con SCS in clinical studies has improved little over the past decade and therefore remains suboptimal, with roughly 50% pain relief for 50% of the patients . In an effort to improve the efficacy of SCS, several alternative stimulation paradigms have been developed.…”

“…1-3 Conventional (Con), or tonic, SCS has proven to be effective for the management of various selected chronic neuropathic pain conditions (which are often refractory to pharmacological tools), such as failed back surgery syndrome and complex regional pain syndrome. [2][3][4][5] Con SCS administers continuous pulses of electrical stimulation to the dorsal columns of the spinal cord with frequencies within the range of 40 to 60 Hz. 6,7 The SCS effect emerges from electrodes implanted in the epidural space between the spinal cord and the vertebral column.…”

“…Despite the positive outcome, the reported success rate of Con SCS in clinical studies has improved little over the past decade and therefore remains suboptimal, with roughly 50% pain relief for 50% of the patients. 4,8 In an effort to improve the efficacy of SCS, several alternative stimulation paradigms have been developed. One such example is burst SCS, a paradigm that uses periodic bursts of pulses rather than continuous pulses as used in Con SCS.…”