Application and future trends of spinal cord stimulation

Abstract

Neuropathic pain impacts 7-10% of the general population and seriously undermines quality of life despite available medications. Although initially approved to treat chronic neuropathic pain as an alternative to conventional medical management, spinal cord stimulation (SCS) is expanding its application prospect to the treatment for an assortment of indications including ischemic pain and neurodegenerative disorders, with new stimulation modalities, techniques, and electrode materials emerging every year. Despite its proven efficacy and cost-effectiveness when compared with the long-term application of insufficiently effective and potentially harmful medications, SCS is still largely neglected by pain physicians and neurosurgeons worldwide because of the exorbitant cost of the devices and possible complications. The mechanism of action, constituents and clinical applications, and performance of SCS are here reviewed, with a special focus on five indications amenable to SCS treatment, including failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), painful diabetic neuropathy (PDN), critical limb ischemia (CLI) and Parkinson's disease (PD). Among all the indications, only FBSS and CRPS have a mature application scenario, and SCS treatment for PDN has just recently been approved by FDA. The clinical study of more conditions that may benefit from SCS treatment, such as CLI and PD, is still underway. Market expectations and recent developments of SCS are further discussed to provide an outlook for the future trends of spinal cord stimulation.