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Spinal cord stimulation: Indications, mechanism of action, and efficacy

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Abstract

Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and their families is staggering. Spinal cord stimulation for the treatment of chronic pain is cost-effective when used in the context of a pain treatment continuum. Many theories on the mechanism of action of spinal cord stimulation have been suggested, including activation of gate control mechanisms, conductance blockade of the spinothalamic tracts, activation of supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms, and activation or release of putative neuromodulators. Whatever theory or theories of mechanism are correct, spinal cord stimulation has efficacy in the treatment of failed back surgery syndrome, complex regional pain syndromes, intractable pain due to peripheral vascular disease, and intractable pain due to angina.

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References and Recommended Reading

  1. The Michigan Pain Study: EPIC/MRA 4710 W. Lansing, Michigan: Saginaw Hwy; 1997:48917–52601. This study underscores the real costs to society and lives if chronic pain is not addressed directly. These costs, as this article presents, are unfathomable.

  2. Law JD: Spinal stimulation: statistical superiority of monophasic stimulation of narrowly separated, longitudinal bipoles having rostral cathodes. Appl Neurophysiol 1983, 46:129–137.

    CAS  PubMed  Google Scholar 

  3. Alo KM, Yland MJ, Kramer DL, et al.: Computer assisted and patient interactive programming of dual octrode spinal cord stimulation in the treatment of chronic pain. Neuromodulation 1998, 1:30–45. Illustrates how patients with severe intractable and complex pain might benefit from implanted, spinal cord systems that allow for multiple programming.

    Article  CAS  PubMed  Google Scholar 

  4. North RB, Ewend MG, Lawton MT, Piantadosi S: Spinal cord stimulation for chronic, intractable pain: superiority of “multi-channel” devices. Pain 1991, 44:119–130.

    Article  CAS  PubMed  Google Scholar 

  5. Barolat G, Schwartzman R, Woo R: Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funct Neurosurg 1989, 53:29–30.

    Article  CAS  PubMed  Google Scholar 

  6. Oakley JC, Weiner RL: Spinal cord stimulation for complex regional pain syndrome: a prospective study of 19 patients at two centers. Neuromodulation 1999, 2:47–50.

    Article  CAS  PubMed  Google Scholar 

  7. 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. This paper, although does not show improvement in longevity of life, shows that SCS is as effective as coronary artery bypass graft in reducing symptoms of intractable angina with less side effects.

    Article  CAS  PubMed  Google Scholar 

  8. Vulink N, Overgaauw DM, Jessurun G, et al.: The effects of spinal cord stimulation on quality of life in patients with therapeutically chronic refractory angina pectoris. Neuromodulation 1999, 2:33–40.

    Article  CAS  PubMed  Google Scholar 

  9. Claeys L: Spinal cord stimulation and chronic critical limb ischemia. Neuromodulation 1999, 2:1–3. This paper, a review article, nicely outlines for the reader what is needed to know regarding mechanism of action of SCS for critical, chronic limb ischemia and indications for the same.

    Article  CAS  PubMed  Google Scholar 

  10. Augustinsson LE, Holm J, Carl A, et al.: Epidural electrical stimulation in severe limb ischemia: evidences of pain relief, increased blood flow and a possible limb saving effect. Ann Surg 1985, 202:104–111.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Jacobs MJ, Jorning PJ, Joshi SR, et al.: Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischaemia. Ann Surg 1988, 207:179–183.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Holsheimer J, Barolat G: Spinal geometry and paresthesia coverage in spinal cord stimulation. Neuromodulation 1998, 1:129–137. Much is not known regarding the electrical effects of SCS. Holsheimer et al. have shown us in this article what we do know and what one can expect when one delivers an electrical field over the spinal cord. From knowledge presented in this paper, the reader can understand the effects of stimulating certain areas of the spinal cord.

    Article  Google Scholar 

  13. Barolat G, Ketcik B, He J: Long-term outcome of spinal cord stimulation for chronic pain management. Neuromodulation 1998, 1:19–30.

    Article  CAS  PubMed  Google Scholar 

  14. 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  CAS  PubMed  Google Scholar 

  15. Holsheimer J, Struijk JJ, Tas NR: Effect of of electrode geometry and combination on nerve fibre selectivity in spinal cord stimulation. Med Biol Eng Comput 1995, 33:676–682.

    Article  CAS  PubMed  Google Scholar 

  16. Wesselink WA, Holsheimer J, Nuttin B, et al.: Estimation of fiber diameters in the spinal dorsal columns from clinical data. IEEE Trans Biomed Eng 1988, 45:1355–1362.

    Article  Google Scholar 

  17. Wesselink WA, Holsheimer J, King GW, et al.: Quantitative aspects of the clinical performance of transverse tripolar spinal cord stimulation. Neuromodulation 1999, 2:5–14.

    Article  CAS  PubMed  Google Scholar 

  18. Alo K: Lead positioning and programming strategies in the treatment of complex pain. Neuromodulation 1999, 2:165–170.

    Article  CAS  PubMed  Google Scholar 

  19. Shealy CN, Mortimer JT, Reswick JB: Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 1967, 46:489–491.

    CAS  PubMed  Google Scholar 

  20. Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965, 150:971–978.

    Article  CAS  PubMed  Google Scholar 

  21. Foreman RD, Beall JE, Coulter JD, et al.: Effects of dorsal column stimulation on primate spinothalamic tract neurons. J Neurophysiol 1976, 39:534–546.

    CAS  PubMed  Google Scholar 

  22. Handwerker HO, Iggo A, Zimmerman M: Segmental and supraspinal actions on dorsal horn neurons responding to noxious and non-noxious skin stimuli. Pain 1975, 1:147–165.

    Article  CAS  PubMed  Google Scholar 

  23. Larson SJ, Sances A Jr, Riegal DH, et al.: Neurophysiological effects of dorsal column stimulation in man and monkey. J Neurosurg 1974, 41:217–223.

    Article  CAS  PubMed  Google Scholar 

  24. Saade NE, Tabe MS, Soueidan SA, et al.: Supraspinal modulation of nociception in awake rats by stimulation of the dorsal column nuclei. Brain Res 1986, 369:307–310.

    Article  CAS  PubMed  Google Scholar 

  25. Linderoth B, Fedorcsak I, Meyerson BA: Is vasodilatation following dorsal column stimulation mediated by antidromic activation of small diameter afferents? Acta Neurochir Suppl (Wein) 1989, 46:99–101.

    Article  CAS  Google Scholar 

  26. Bayliss WM: On the origin from the spinal cord of the vasodilator fibers of the hind-limb and on the nature of these fibers. J Physiol 1987, 382:173–209.

    Google Scholar 

  27. Linderoth B: Dorsal column stimulation and pain: experimental studies of putative neurochemical and neurophysiological mechanisms [itPhD thesis]. Stockholm: Karolinska Institute; 1992.

    Google Scholar 

  28. Croom JE, Foreman RD, Chandler M, Barron KW: Reevaluation of the role of the sympathetic nervous system in cutaneous vasodilation during dorsal spinal cord stimulation: are multiple mechanisms active? Neuromodulation 1998, 1:91–101.

    Article  CAS  PubMed  Google Scholar 

  29. Fedorcsak I, Linderoth B, Bognar L, et al.: Peripheral vasodilation due to sympathetic inhibition induced by spinal cord stimulation. Proceedings IBRO World Congress of Neuroscience; 1991:126.

  30. Levin BE, Hubschmann OR: Dorsal column stimulation: effect on human cerebrospinal fluid and plasma catecholamines. Neurology 1980, 30:65–71.

    Article  CAS  PubMed  Google Scholar 

  31. Meyerson BA, Brodin E, Linderoth B: Possible neurohumoral mechanisms in CNS stimulation for pain suppression. Appl Neurophysiol 1985, 48:175–180.

    CAS  PubMed  Google Scholar 

  32. Freemen TB, Campbell JN, Long DM: Naloxone does not affect pain relief induced by electrical stimulation in man. Pain 1983, 17:189–195.

    Article  Google Scholar 

  33. Tonelli L, Setti T, Falasca A, et al.: Investigation on cerebrospinal fluid opioids and neurotransmitters related to spinal cord stimulation. Appl Neurophysiol 1988, 51:324–332.

    CAS  PubMed  Google Scholar 

  34. Broggi G, Franzini A, Parati E, et al.: Neurochemical and structural modifications related to pain control induced by spinal cord stimulation. In Neurostimulation: An Overview. Edited by Lazorthes Y, Upton ARM. Armonk, NY: Futura Publishing; 1985:87–95.

    Google Scholar 

  35. Richardson DE, Dempsey CW: Monoamine turnover in CSF of patients during spinal cord stimulation for pain control. Pain Suppl 1984, 2:223.

    Google Scholar 

  36. Linderoth B, Gazelius B, Frank J, Brodin E: Dorsal column stimulation induces release of seratonin and substance P in the cat dorsal horn. Neurosurgery 1992, 31:289–296.

    Article  CAS  PubMed  Google Scholar 

  37. Cui JG, Sollevi A, Linderoth B, Meyerson BA: Adenosine receptor activation suppresses tactile hypersensitivity and potentiates effect of spinal cord in mononeuropathic rats. Neurosci Lett 1997, 223:173–176.

    Article  CAS  PubMed  Google Scholar 

  38. Cui JG, Meyerson BA, Sollevi A, Linderoth B: Effects of spinal cord stimulation on tactile hypersensitivity in mononeuropathic rats is potentiated by GABA-B and adenosine receptor activation. Neurosci Lett 1998, 247:183–186.

    Article  CAS  PubMed  Google Scholar 

  39. Meyerson BA, Cui JG, 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  CAS  PubMed  Google Scholar 

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Krames, E. Spinal cord stimulation: Indications, mechanism of action, and efficacy. Current Review of Pain 3, 419–426 (1999). https://doi.org/10.1007/s11916-999-0068-z

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