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Spinal cord stimulation and limb ischemia: Neurophysiological mechanisms involved in pain relief

Neurophysiologische Wirkmechanismen der Rückenmarkstimulation auf den ischämischen Schmerz

  • Main Topics: Spinal Cord Stimulation In The Treatment Of Chronic Critical Limb Ischemia And Angina Pectoris
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: Spinal cord stimulation is a spin-off of the well-known “Gate Control Theory of Pain” presented byMelzack undWall in 1965. However, up to now very little is known about the mechanisms behind the beneficial effects.

Methods: Several different mechanisms are activated by spinal cord stimulation. The present state of knowledge is reviewed.

Results: The “Gate Control Theory of Pain” comprehends a model in which the nociceptive unmyelated afferents are inhibited by stimulation of non-nociceptive myelinated afferents. Although the concept of this theory is not longer tenable in all its aspects, the idea remains unchanged. At present, several hypotheses are discussed: a simple blocking of pain transmission by a direct effect on the spinothalamic tracts, activation of descending inhibitory pathways, segmental inhibition via coarse fibre activation and brain stem loops to thalamocortical mechanisms, long-term suppression of the sympathic activity and antidromic effects on peripheral reflex circuits and the release of neurotransmitters.

Conclusions: Several different mechanisms are activated by spinal cord stimulation. Further research is necessary to increase knowledge of the neurophysiological and neurochemical changes activated by stimulation.

Zusammenfassung

Grundlagen: Das Konzept der epiduralen Rückenmarkstimulation geht auf die „Gate Control Theory of Pain“ vonMelzack undWall zurück. Bis heute sind die Wirkmechanismen jedoch nicht sicher geklärt.

Methodik: Die vorliegende Arbeit soll einen Überblick über den gegenwärtigen Stand der postulierten Wirkmechanismen der epiduralen Rückenmarkstimulation geben.

Ergebnisse: Die „Gate Control Theory“ besagt, daß die elektrische, nicht schmerzhafte Reizung dickkalibriger afferenter Fasern im Rückenmark die nozizeptiven Aktivitäten auf segmentaler Ebene des Rückenmarks und über Interneurone hemmt. Diese Theorie kann jedoch nicht alle Effekte erklären. Folgende Hypothesen werden heute diskutiert: Ein direkter Einfluß der Stimulation auf segmentaler Ebene im Rückenmark durch präsynaptische Hemmung nozizeptiver Impulse, die Aktivierung von „Long Loop“-Reflexen, die auf höherer mesenzephaler und thalamischer Ebene eine Schmerzmodulation bewirken, eine Verringerung des Sympathikotonus mit nachfolgender Verbesserung der Mikrozirkulation der Haut, die Freisetzung von endogenen Substanzen, die direkt auf segmentaler oder supraspinaler Ebene nozizeptive Afferenzen blockieren, und eine antidromische Stimulation der langsamleitenden Fasern, welche eine Vasodilatation verursacht.

Schlußfolgerungen: Verschiedene Hypothesen helfen uns, die Effekte der Rückenmarkstimulation besser zu verstehen. Weitere experimentelle Untersuchungen sind jedoch notwendig, um die schmerzhemmende Wirkung zu erklären.

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Authors and Affiliations

  1. Department of Vascular Surgery, Marienhospital, Ruhr University of Bochum, Hölleskampring 40, D-44625, Herne, Germany

    L. G. Y. Claeys

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Claeys, L.G.Y. Spinal cord stimulation and limb ischemia: Neurophysiological mechanisms involved in pain relief. Acta Chir. Austriaca 32, 45–48 (2000). https://doi.org/10.1007/BF02949226

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  • DOI: https://doi.org/10.1007/BF02949226

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