Spinal cord stimulation for lower limb ischemic pain treatment

Abstract

the endovascular approach reduced the number of patients unsuitable for revascularization, however, some patients cannot be treated by angioplasty or open surgery; moreover, some are unfit for surgery, and others have persistent distal ischemia and pain with a functioning revascularization. In these cases SCS (alone or associated with prostanoids) can be indicated on the basis of the more recent evidences. A trial period with external stimulator, associated with a microcirculatory evaluation, is currently utilized to select patients that can derive benefit from this treatment, reducing costs.

Spinal Cord Stimulation for Chronic Limb Ischemia

“…The electrodes in the epidural space stimulate sensory unmyelinated c-fibers and myelinated Aδ-fibers in the dorsal root ganglia. 7,13,14 This leads to the activation of cell-signaling molecules such as extracellular signal-regulated kinase (ERK) and protein kinase B (AKT). Activated ERK and AKT stimulate the transient receptor potential vanilloid receptor 1 (TRPV1).…”

“…These effects lead to a decrease in vascular resistance and an increase in local blood flow ( Figure 1). 7,8,15,16 In addition, SCS suppresses sympathetic vasoconstriction through inhibition of sympathetic nicotine transmission at the ganglionar and postganglionar level. 3,4,7 Pain relief is mediated by the suppression of pain or nociceptive transmission and the release of opioid peptides such as met-enkephalin.…”

“…9 Predrini and Magnoni reviewed the efficacy of SCS in patients with untreatable CLI and found that pain relief, ulcer healing, and limb salvage were greater in nondiabetic patients, in diabetic patients without autonomic neuropathy, and in patients with rest pain or ulcer more often than in patients with gangrene. 7 The Cochrane review of SCS for nonreconstructable CLI found that limb salvage after 12 months was significantly higher in patients with the device. Pain relief was also more prominent in the SCStreated patients, and they required significantly less analgesics.…”

“…Some patients may have medical comorbidities that render them unfit for surgery, whereas others may have persistent ischemia or pain even in the face of previous attempts at reperfusion. 7 In these patients, the aim J.J. Naoum, M.D.…”

Epidurale Rückenmarkstimulation zur Therapie chronischer Schmerzen

“…5-50), um eine Extremität zu erhalten, das relative Risiko 0,74 (95% Konfidenzintervall 0,57-0,94) zugunsten der Stimulation. Zu ähnlichen Ergebnissen kommt eine aktuelle Literaturübersicht aus Italien [35]. Für andere Durchblutungsstörungen, z.…”