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Stimulation methods for neuropathic pain control

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Abstract

Neurostimulation methods for control of chronic neuropathic pain have recently gained in popularity. The reasons for this are mutifactorial. As opposed to nerve ablation, these methods are minimally invasive and reversible. The improvements in hardware design simplified implantation techniques and prolonged equipment longevity. Stimulation trials have become less invasive, allowing patients to test its effects before final implantation. Finally, the scientific evidence has shown good outcomes of neurostimulation methods for chronic neuropathic pain control. Recent research efforts have revealed new potential mechanisms of action of neurostimulation. Whereas its action was widely explained by gate control theory in the past, it seems that neuromodulation acts also by modulation of neurotransmitters in the central nervous system.

Three neurostimulation methods are currently used in clinical practice: spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), and deep brain stimulation (DBS). The SCS and PNS are excellent treatment choices for certain forms of neuropathic pain. The new indications for SCS are end-stage peripheral vascular disease and ischemic heart disease, whereas PNS is used for the treatment of occipital neuralgia and chronic pelvic pain. DBS is reserved for carefully selected patients in whom the other treatment modalities have failed. In a minority of patients the "tolerance" to neurostimulation develops after long-term use. Further research is needed to establish better outcome predictors to neurostimulation and possibly improve patient selection criteria.

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References and Recommended Reading

  1. Melzack R, Wall P: Pain mechanism: a new theory. Science 1965, 150:951–979.

    Article  Google Scholar 

  2. Shealy C, Mortimer J, Reswick J: Electrical inhibition of pain by stimulation of the dorsal columns: preliminary report. Anesth Analg 1967, 46:489–491.

    PubMed  CAS  Google Scholar 

  3. Krames E: Spinal cord stimulation: indications, mechanism of action, and efficacy. Curr Rev Pain 1999, 3:419–426.

    PubMed  Google Scholar 

  4. Dubuisson D: Effect of dorsal-column stimulation on gelatinosa and marginal neurons of cat spinal cord. J Neurosurg 1989, 70:257–265.

    PubMed  CAS  Google Scholar 

  5. Meyerson B, Linderoth B: Mechanisms of spinal cord stimulation in neuropathic pain. Neurolog Res 2000, 22:285–292. Excellent review of putative mechanisms of action of SCS.

    CAS  Google Scholar 

  6. Linderoth B, Foreman R: Physiology of spinal cord stimulation: review and update. Neuromodulation 1999, (2-3):150–164.

    Article  Google Scholar 

  7. Yakhnitsa V, Linderoth B, Meyerson BA: Spinal cord stimulation attenuates dorsal horn neuronal hyperexcitability in a rat model of mononeuropathy. Pain 1999, 79:223–233.

    Article  PubMed  CAS  Google Scholar 

  8. Bennett G: An animal model of neuropathic pain: a review. Muscle Nerve 1993, 16:1040–1048.

    Article  PubMed  CAS  Google Scholar 

  9. Stiller C-O, Cui C-G, O’Connor WT, et al.: Release of GABA in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery 1996, 39:367–375.

    Article  PubMed  CAS  Google Scholar 

  10. Cui JG, O’Connor WT, Ungerstedt U, et al.: Spinal cord stimulation attenuates dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain 1997, 73:87–95.

    Article  PubMed  CAS  Google Scholar 

  11. Cui JG, Linderoth B, Meyerson BA: Effects of spinal cord stimulation on touch evoked allodynia involve GABAergic mechanisms. An experimental study in mononeuropathic rat. Pain 1996, 66:287–295.

    Article  PubMed  CAS  Google Scholar 

  12. Meyerson BA, Cui J-G, Yakhnitsa V, et al.: Modulation of spinal pain mechanisms by spinal cord stimulation and the potential role of adjuvant pharmacotherapy. Stereotact Funct Neurosurg 1997, 68:129–140.

    Article  PubMed  CAS  Google Scholar 

  13. Stiller C-O, Linderoth B, O’Connor W, et al.: Repeated spinal cord stimulation decreases the extracellular level of gamma-aminobutiric acid in periaqueductal grey matter of freely moving rats. Brain Res 1995, 699:231–241.

    Article  PubMed  CAS  Google Scholar 

  14. Linderoth B, Gazelius B, Franck J, et al.: Dorsal column stimulation induces release of serotonin and substance P in the cat dorsal horn. Neurosurgery 1992, 31:289–296.

    Article  PubMed  CAS  Google Scholar 

  15. Croom JE, Foreman RD, Chandler MJ, et al.: Cutaneous vasodilatation during dorsal column stimulation is mediated by dorsal roots and CGRP. Am J Physiol 1997, 272:H950-H957.

    PubMed  CAS  Google Scholar 

  16. Gheradini G, Lundenberg T, Cui J-G, et al.: Spinal cord stimulation improves survival in ischemic skin flaps: an experimental study of the possible mediation by calcitonin gene-related peptide. Plast Reconstr Surg 1999, 103:1221–1228.

    Article  Google Scholar 

  17. Kemler MA, Barendse GA, van Kleef M, et al.: Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation. Anesthesiology 2000, 92:1653–1660.

    Article  PubMed  CAS  Google Scholar 

  18. Hautvast RWM, Dejongste MJL, Blansma PK, et al.: Spinal cord stimulation causes redistribution in myocardial perfusion during dypiridamole stress testing in patients with refractory angina pectoris as assessed by 13 NH3-positron emission tomography. Am J Cardiol 1996, 77:462–467.

    Article  PubMed  CAS  Google Scholar 

  19. Foreman RD, Linderoth B, Ardell JL, et al.: Modulation of intrinsic cardiac neurons by spinal cord stimulation: implications for its therapeutic use in angina pectoris. Cardiovasc Res 2000, 47:367–375.

    Article  PubMed  CAS  Google Scholar 

  20. Kiriakopoulos ET, Tasker RR, Nicosia S, et al.: Functional magnetic resonance imaging: a potential tool for the evaluation of spinal cord stimulation: technical case report. Neurosurgery 1997, 41:501–504.

    Article  PubMed  CAS  Google Scholar 

  21. Kumar K, Nath R, Wyant GM: Treatment of chronic pain by epidural spinal cord stimulation: a 10 year experience. J Neurosurg 1991, 75:402–407.

    PubMed  CAS  Google Scholar 

  22. North RB, Kidd DH, Lee MS, et al.: Spinal cord stimulation versus reoperation for the failed back surgery syndrome: a prospective randomized study design. Stereotact Funct Neurosurg 1994, 62:267–272.

    Article  PubMed  CAS  Google Scholar 

  23. North RB, Ewend MG, Lawton MT: Failed back surgery syndrome: five year follow up after spinal cord stimulator implantation. A prospective, randomized study design. Neurosurgery 1991, 28:692–699.

    Article  PubMed  CAS  Google Scholar 

  24. Burchiel KJ, Anderson VC, Brown FD, et al.: Prospective multicenter study of spinal cord stimulation for relief of chronic back and extremity pain. Spine 1996, 21:2786–2794.

    Article  PubMed  CAS  Google Scholar 

  25. Kolin M-T, Winkelmuller W: Chronic pain after multiple lumbar disectomies—lsignificance of intermittent spinal cord stimulation. Pain 1990, 5:S241.

    Article  Google Scholar 

  26. Turner JA, Loeser JD, Bell KG: Spinal cord stimulation for chronic low back pain: a systematic literature synthesis. Neurosurgery 1995, 37:1088–1096.

    Article  PubMed  CAS  Google Scholar 

  27. De Laporte C, Van de Kelft E: Spinal cord stimulation in failed back surgery syndrome. Pain 1993, 52:55–61.

    Article  Google Scholar 

  28. Ohnmeiss DD, Rashbaum RF, Bogdanffy GM: Prospective outcome evaluation of spinal cord stimulation in patients with intractable leg pain. Spine 1996, 21:1344–1351.

    Article  PubMed  CAS  Google Scholar 

  29. Sanchez-Ledesma MJ, Garcia-March G, Diaz-Cascajo PG, et al.: Spinal cord stimulation in deafferentation pain. Stereotact Funct Neurosurg 1989, 53:40–55.

    Article  PubMed  CAS  Google Scholar 

  30. Sweet W, Wepsic J: Stimulation of the posterior columns of the spinal cord for pain control. Clin Neurosurg 1974, 21:278–310.

    PubMed  CAS  Google Scholar 

  31. Meilman PW, Leibrock LG, Leong FTL: Outcome of implanted spinal cord stimulation in the treatment of chronic pain: arachnoiditis versus single nerve root injury and mononeuropathy. Clin J Pain 1989, 5:189–193.

    Article  PubMed  CAS  Google Scholar 

  32. North RB, Kidd DH, Zahurak M, et al.: Spinal cord stimulation for chronic intractable pain: two decade’s experience. Neurosurgery 1993, 32:384–395.

    Article  PubMed  CAS  Google Scholar 

  33. Law JD: Spinal cord stimulation in the "failed back surgery syndrome." Comparison of technical criteria for palliating pain in the leg versus in the low back. Acta Neurochir 1992, 117:95.

    Google Scholar 

  34. Bartolat G: A prospective multicenter study to assess the efficacy of spinal cord stimulation utilizing multi-channel radio-frequency system for the treatment of intractable low back pain and lower extremity pain. Initial considerations and methodology. Neuromodulation 1999, (2-3):179–183.

    Article  Google Scholar 

  35. North RB: Spinal cord stimulation for axial low back pain: single versus dual percutaneous electrodes.In International Neuromodulation Society Abstracts, Lucerne, Switzerland. 1998:212.

  36. Alo KM, Yland MJ, Redko V, et al.: Lumbar and sacral nerve root stimulation (NRS) in the treatment of chronic pain, a novel anathomic approach and neurostimulation technique. Neuromodulation 1999, 2:19–27.

    Google Scholar 

  37. North RB, Guarino A: Spinal cord stimulation for failed back surgery syndrome: technical advances, patient selection and outcome. Neuromodulation 1999, (2-3):171–178. Excellent review on the SCS role in the treatment of FBSS.

    Article  Google Scholar 

  38. Mitchell SW, Morehouse G, Keen WW: Gunshot Wounds and Other Injuries to the Nerves. Philadelphia: J.B. Lippincott; 1864.

    Google Scholar 

  39. Stanton-Hicks M: Spinal cord stimulation for the management of complex regional pain syndromes. Neurostimulation 1999, (2-3):193–201. Excellent review of SCS in patients with CRPS.

    Article  Google Scholar 

  40. Kumar K, Toth C, Nath RK: Spinal cord stimulation is effective in reflex sympathetic dystrophy. Neurosurgery 1997, 40:503–509.

    Article  PubMed  CAS  Google Scholar 

  41. Bartolat G, Swartzman R, Woo R: Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotac Funct Neurosurg 1989, 53:29–39.

    Article  Google Scholar 

  42. Oakley JC, Weiner RL: Spinal cord stimulation for comlex regional pain syndrome. A prospective study of 19 patients. Neuromodulation 1999, 2:47–50.

    Article  Google Scholar 

  43. Kemler MA, Barendse GA, van Kleef M, et al.: Electrical spinal cord stimulation in reflex sympathetic dystrophy: retrospective analysis of 23 patients. J Neurosurg 1999, 90:79–83.

    PubMed  CAS  Google Scholar 

  44. Benett DS, Alo KM, Oakley J, et al.: Spinal cord stimulation for complex regional pain syndrome: a retrospective multicenter experience from 1995 to 1998 of 101 patients. Neuromodulation 1999, (2-3):202–210.

    Article  Google Scholar 

  45. Kemler MA, Barendse GAM, van Kleef M, et al.: Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000, 343:618–624. Randomized study for SCS treatment of CRPS.

    Article  PubMed  CAS  Google Scholar 

  46. Calvillo O, Racz G, Dedie J, et al.: Neuroaugmentation in the treatment of CRPS of the upper extremity. Acta Orthop Belg 1998, 64:57–63.

    PubMed  CAS  Google Scholar 

  47. van Hilten BJ, van de Beek W-JT, Holf JI: Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy. N Engl J Med 2000, 343:625–630.

    Article  PubMed  Google Scholar 

  48. Kumar K, Toth C, Nath RK, et al.: Epidural spinal cord stimulation for treatment of chronic pain-some predictors of success. A fifteen year experience. Surg Neurol 1988, 50:110–121.

    Article  Google Scholar 

  49. Petrakis IE, Sciacca V: Spinal cord stimulation in diabetic lower limb critical ischaemia: transcutaneous oxygen measurement as predictor for treatment success. Eur J Vasc Endovasc Surg 2000, 19:587–592.

    Article  PubMed  CAS  Google Scholar 

  50. Torrens JK, Stanley PJ, Ragunathan PL, et al.: Risk of infection with electrical spinal-cord stimulation [letter]. Lancet 1997, 349:729.

    Article  PubMed  CAS  Google Scholar 

  51. DeJongste MJ: Spinal cord stimulation for ischemic heart disease. Neurol Res 2000, 22:293–298. Excellent review of SCS use in ischemic heart disease.

    PubMed  CAS  Google Scholar 

  52. Mannheimer C, Eliasson T, Augustinsson LE, et al.: Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation 1998, 97:1157–1163.

    PubMed  CAS  Google Scholar 

  53. Romano M, Auriti A, Cazzin R, et al.: Epidural spinal stimulation in the treatment of refractory angina pectoris. Its clinical efficacy, complications and long-term mortality. Ital Heart J 2000, 1(suppl:1):97–102.

    CAS  Google Scholar 

  54. Fanciullo GJ, Robb JF, Rose RJ, et al.: Spinal cord stimulation for intractable angina pectoris. Anesth Analg 1999, 89:305–306.

    Article  PubMed  CAS  Google Scholar 

  55. Hautvast RW, DeJongste MJ, Staal MJ, et al.: Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study. Am Heart J 1998, 136:1114–1120.

    Article  PubMed  CAS  Google Scholar 

  56. Jessurun GA, Ten Vaarwerk IA, DeJongste MJ, et al.: Sequelae of spinal cord stimulation for refractory angina pectoris. Reliability and safety profile of long-term clinical application. Coron Artery Dis 1997, 8:33–38.

    Article  PubMed  CAS  Google Scholar 

  57. Hautvast RW, Brouer JW, Dejongste MJ, et al.: Effect of spinal cord stimulation on heart rate variability and myocardial ischemia in patients with chronic intractable angina pectoris: a prospective ambulatory electrocardiographic study. Clin Cardiol 1998, 21:33–38.

    Article  PubMed  CAS  Google Scholar 

  58. Dejongste MJL, Hautvast RWM, Hillege H, et al.: Efficacy of spinal cord stimulationas an adjuvant therapy for intractable angina pectoris: a prospective randomized clinical study. J Am Coll Cardiol 1994, 23:1592–1597.

    Article  CAS  Google Scholar 

  59. Broseta J, Barbera J, de Vera J, et al.: Spinal cord stimulation in peripheral arterial disease. J Neurosurg 1986, 64:71–80.

    PubMed  CAS  Google Scholar 

  60. Claeys L: Spinal cord stimulationfor peripheral vascular disease: a critical review-European studies. Pain Digest 1999, 9:337–341. Excellent review on SCS in peripheral vascular disease.

    Google Scholar 

  61. Huber S, Vagilenti R, Midcap R, et al.: Enchansed limb salvage for peripheral vascular diseasewith the use of spinal cord stimulation. W V Med J 1996, 92:89–91.

    PubMed  CAS  Google Scholar 

  62. Kumar K, Toth C, Nath RK, et al.: Improvement of limb circulation in peripheral vascular disease using epidural spinal cord stimulation: a prospective study. J Neurosurg 1997, 86:662–669.

    Article  PubMed  CAS  Google Scholar 

  63. Petrakis IE, Sciacca V: Spinal cord stimulation in critical limb ischemia of the lower extremities: our experience. J Neurosurg Sci 1999, 43:285–293.

    PubMed  CAS  Google Scholar 

  64. Petrakis E, Sciacca V: Prospective study of transcutaneous oxygen tension (TcPO2) measurement in the testing period of spinal cord stimulation in diabetic patients with critical lower limb ischaemia. Intern Angiol 2000, 19:18–25.

    CAS  Google Scholar 

  65. Spincemaille GH, Klomp HM, Steyerberg EW, Habbema JD: Pain and quality of life in patients with critical limb ischaemia: results of a randomized controlled multicentre study on the effect of spinal cord stimulation. ESES study group. Eur J Pain 2000, 4:173–184.

    Article  PubMed  CAS  Google Scholar 

  66. Villavicencio AT, Leveque JC, Rubin L, et al.: Laminectomy versus percutaneous electrode placement for spinal cord stimulation. Neurosurgery 2000, 46:399–405.

    Article  PubMed  CAS  Google Scholar 

  67. Iyer R, Gnanadurai TV, Forsey P: Management of cardiac pacemaker in a patient with spinal cord stimulator implant. Pain 1988, 74:333–335.

    Article  Google Scholar 

  68. Law J, Sweet J, Kirsch W: Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation. J Neurosurg 1980, 52:482–485.

    PubMed  CAS  Google Scholar 

  69. Shetter A, Racz G, Lewis R, Heavner J: Peripheral nerve stimulation. In Neurosurgical Management of Pain.Edited by North R, Levy R. New York: Springler-Verlag; 1997:261–270.

    Google Scholar 

  70. Campbell J, Taub A: Local analgesia from percutaneous electrical stimulation. A peripheral mechanism. Arch Neurol 1973, 28:347–350.

    PubMed  CAS  Google Scholar 

  71. Campbell J, Long D: Peripheral nerve stimulation in the treatment of intractable pain. J Neurosurg 1976, 45:692–699.

    PubMed  CAS  Google Scholar 

  72. Weiner RL, Reed KL: Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation 1999, (2-3):217–221.

    Article  Google Scholar 

  73. Feler CA, Whitwoth LA, Brookoff, et al.: Recent advances: Sacral nerve root stimulation using a retrograde method of lead insertion for the treatment of pelvic pain due to interstitial cystitis. Neuromodulation 1999, (2-3):211–216.

    Article  Google Scholar 

  74. Meyerson BA, Electrostimulation procedures: Effects, presumed rationale, and possible mechanisms, In Advances in Pain Research and Therapy, vol 5. Edited by Bonica JJ et al. New York: Raven Press; 1983:495–534.

    Google Scholar 

  75. Hosobuchi Y: Subcortical electrical stimulation of gray matter for control of intractable pain in humans. Report of 122 cases (1970-1984). J Neurosurg 1986, 64:543–553.

    Article  PubMed  CAS  Google Scholar 

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  1. MGH Pain Center, Department of Anesthesia and Critical Care, Massachusetts General Hospital, 15 Parkman Street, 02114, Boston, MA, USA

    Milan P. Stojanovic MD

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Stojanovic, M.P. Stimulation methods for neuropathic pain control. Current Science Inc 5, 130–137 (2001). https://doi.org/10.1007/s11916-001-0081-3

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