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Spinal Cord Stimulation

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Essentials of Interventional Techniques in Managing Chronic Pain

Abstract

The term spinal cord stimulation (SCS) describes the electrical stimulation of the dorsal column via electrode arrays implanted in the epidural space of a spinal level associated with a painful dermatome. Conventional SCS uses electrical pulses delivered at relatively low frequency (~50 Hz) using array designs that can be customized to patient needs. Electrical current can be adjusted to stimulate and induce paresthesias in large fibers of the dorsal columns, in turn closing the gate to the nociceptive fibers transmitting input to the brain. Recent stimulation paradigms (HF, burst) have shown to be clinically effective without the need for paresthesias, implying that the stimulating electrical field modulates pain signals via alternative mechanisms. SCS is a minimally invasive therapy that has proven to be effective for the treatment of chronic neuropathic pain in which conservative management has failed. Best levels of evidence support SCS efficacy in low back pain indications such as failed back surgery syndrome (FBSS), as well as in complex regional pain syndromes (CRPS). There is also evidence of positive outcomes for treating neuropathies, abdominal/pelvic pain, and ischemic-related pain syndromes. Technological advances in lead design, battery efficiency, and pulse programming, in combination with properly designed randomized clinical trials, will continue to make SCS an effective alternative therapy for chronic painful conditions.

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Acknowledgments

This book chapter is modified and updated from a previous book chapter, “Spinal Cord Stimulation” by Ricardo Vallejo, MD, PhD; Ramsin M. Benyamin, MD; Jeffery Kramer, PhD; and Donny Bounds, MSN, in Interventional Techniques in Chronic Spinal Pain published by ASIPP Publishing. Permission has been obtained from ASIPP Publishing.

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Authors and Affiliations

  1. Millennium Pain Center, Bloomington, IL, 61704, USA

    Ramsin Benyamin, Ricardo Vallejo & David L. Cedeño

  2. College of Medicine, University of Illinois, Champaign-Urbana, IL, USA

    Ramsin Benyamin

Authors
  1. Ramsin Benyamin
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  2. Ricardo Vallejo
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  3. David L. Cedeño
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Correspondence to Ramsin Benyamin .

Editor information

Editors and Affiliations

  1. Pain Management Center of Paducah, Paducah, Kentucky

    Laxmaiah Manchikanti

  2. Department of Anesthesia, LSU Health Science Center, New Orleans, Louisiana, USA

    Alan D. Kaye

  3. Mid Atlantic Spine and Pain Physicians, Newark, Delaware

    Frank J.E. Falco

  4. Service Line Chief of Interventional Radiology, Director of Interventional Neuroradiology, Chief of NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA

    Joshua A. Hirsch

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Benyamin, R., Vallejo, R., Cedeño, D.L. (2018). Spinal Cord Stimulation. In: Manchikanti, L., Kaye, A., Falco, F., Hirsch, J. (eds) Essentials of Interventional Techniques in Managing Chronic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-60361-2_44

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  • DOI: https://doi.org/10.1007/978-3-319-60361-2_44

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