Neurostimulation technology for the treatment of chronic pain: a focus on spinal cord stimulation

Abstract

Over the past 40 years we have seen how electrical stimulation for the relief of pain has progressed from an experimental treatment based upon a clinical theory to being on the threshold of becoming a standard of medical practice. While tens of thousands of devices are implanted every year, the mechanism of action still evades complete understanding. Nevertheless, technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable. Unlike most conventional treatments, neurostimulation cannot be restricted to one speciality as its clinical applications ignore the boundaries of medical specialities. Conditions such as neuropathic pain in the back and the leg, complex regional pain syndrome, ischemic pain due to peripheral vascular disease and coronary artery disease are likely to respond to spinal cord stimulation. Even though the evidence for efficacy remains unsatisfactory, the stimulation of the dorsal column has been remarkably successful in relieving pain and improving function in patients who have failed conventional management. The development, the technicalities and the most important clinical applications of spinal cord stimulation are reviewed here.

Managing chronic pain: results from an open-label study using MC5-A Calmare® device

“…Although the risk of a placebo effect obviously existed, such effects reported in the literature are much lower (9% efficacy in placebo arm) than the reduction in pain observed by us [12]. Pain reduction at T0 was around 74% and at T2 was similar to that reported in previous studies carried out on the device [10,18,19] and on other instruments using direct nerve stimulation [11][12][13].…”

“…Various hypotheses have been put forward to explain the mechanisms of action for the clinical benefit obtained from electrical nerve stimulation, e.g., supraspinal processes, modulation of descending inhibitor pathways, peripheral release of calcitonin, increase in gate control for pain threshold, reduction in windup phenomenon, and reduction in impulses from damaged nerves [8,10,11].…”

Spinal cord direct current stimulation: finite element analysis of the electric field and current density

“…Its most extended use is in the form of short (ls) pulses delivered by implanted electrodes to activate neurons that relieve symptoms of a disease [45] for example, spinal cord stimulation to alleviate pain [15] or stimulation of the basal ganglia and diencephalic structures for treating motor impairments in Parkinson's disease [47]. Charge-balanced biphasic stimulus waveforms are preferred in such applications because they prevent electrochemical reactions that produce toxic molecules at the electrode/tissue interface [30].…”

Whither Suffering? The Potential Impact of Tort Reform on the Emotional and Existential Healing of Traumatically Injured Chronic Pain Patients

“…In a recent article on the epidemic overtreatment of back pain in the USA ), the authors attribute much of this deterioration in care to the failure of practitioners to follow evidence bases. Commonly utilized approaches that lack an evidence basis and often result in debilitating iatrogenic complications include chronic opioid therapy (e.g., Ballantyne 2007a, b;Chou et al 2009), various interventional approaches (e.g., Armon et al 2007;Levin 2009;Scott et al 2009), implantable devices such as spinal cord stimulators (Coffey and Lozano 2006;Foletti et al 2007;Rosenow et al 2006) and intrathecal drug delivery systems (Knight et al 2007;Ruan 2007;Turner et al 2007), and frequently unnecessary and inefficacious surgeries (e.g., Fouyas et al 2007;Pai and Sundaram 2004). Additionally, the stigma associated with chronic pain has been established as adversely affecting medical professionals' attitudes toward and treatment of these patients (Chen et al 2007;Lillrank 2003;Weinstein et al 2000).…”