a peripheral nerve or dorsal column stimulator

A PERIPHERAL NERVE OR DORSAL COLUMN STIMULATOR TRIAL

This theory proposed that nociceptive impulses, which were carried by Aδ and C fibers, might be blocked by simultaneous tactile stimuli or by the electrical stimulation of thick myelinated Aβ fibers. In spite of these antique reports, it was not until 1965 that Melzack and Wall published their gate theory, allowing SCS to emerge as a new technique for achieving pain relief. Both the poor results and frequent accidents led to the prohibition of the technique. In the eighteenth century, the use of electrical current for treating pain was widespread and indiscriminate. According to historical records, the first time electricity was used in medicine was in the time of the Roman Empire, where the torpedo fish was used to treat headaches and painful gout. Įlectricity has been used in medicine since almost two thousand years ago. Due to its reversibility and safety, neuromodulative approaches are preferred over neuroablative procedures, which have been more commonly performed in the previous era. Spinal cord stimulation is a technique of neuromodulation, which consists of placing leads in the epidural space of the spinal cord, as a method to treat numerous types of disturbances. With regard to pain treatment, low frequency is applied to activate dorsal spinal tracts, periaqueductal gray matter, and motor cortex, while inhibitory stimulation is utilized for peripheral nerve, thalamic, and hypothalamic modulation. At present, neuromodulation is used for several neurological conditions such as epilepsy, movement disorders, psychiatric disease, spasticity and pain. Low frequency electrical stimulation has an excitatory effect, whereas, high frequency stimulation is applied to produce neuronal inhibition. The term neuromodulation is preferred over the term stimulation, as the former includes the excitation and inhibition techniques in a clearer fashion. The International Neuromodulation Society established that: Neuromodulation is defined as, “the therapeutic alteration of activity in the central, peripheral or autonomic nervous systems, electrically or pharmacologically, by means of implanted devices”. Neuromodulation is defined as the application of either an electric current or pharmacological agents used to change the neuron membrane permeability to ions, leading to an increase or decrease in its threshold for action potentials. Keywords: Failed back surgery syndrome, indications, neuromodulation, review, spinal cord stimulation Undoubtedly, this proper selection and a better knowledge of its underlying mechanisms of action, will allow this cutting edge technique to be more acceptable among pain physicians.

A PERIPHERAL NERVE OR DORSAL COLUMN STIMULATOR TRIAL

Further indications may be phantom limb pain, chronic intractable pain located in the head, face, neck, or upper extremities, spinal lumbar stenosis in patients who are not surgical candidates, and others.Ĭonclusion:Spinal cord stimulation is a useful tool for neuromodulation, if an accurate patient selection is carried out prior, which should include a trial period. Also, this technique is useful in patients with refractory angina and critical limb ischemia, in whom surgical or endovascular treatment cannot be performed. Failed back surgery syndrome (FBSS) is the most common indication for SCS, whereas, the complex regional pain syndrome (CRPS) is the second one. At present, the indications of SCS are being revised constantly, while new applications are being proposed and researched worldwide. The mechanism of action of SCS would be based on the antidromic activation of the dorsal column fibers, which activate the inhibitory interneurons within the dorsal horn. Results:In spite of the existence of several studies that try to prove the mechanism of action of SCS, it still remains unknown. Methods:This article is a non-systematic review of the mechanism of action, indications, results, programming parameters, complications, and cost-effectiveness of SCS. Following that, technological progress, among other advances, helped SCS become an effective tool to reduce pain. Background:Spinal cord stimulation (SCS) has been used to treat neuropathic pain since 1967.

A peripheral nerve or dorsal column stimulator