Spinal cord stimulation in chronic pain syndromes

Vaarwerk, I. A. M. Ten; Staal, Michiel J.

doi:10.1038/sj.sc.3100741

Cited by 31 publications

(15 citation statements)

References 48 publications

(89 reference statements)

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“…14 The most familiar non-pharmaceutical alternative for pain management, transcutaneous electrical nerve stimulation (TENS), is of limited use in chronic pain 15 such as that associated with SCI. A variant, spinal cord stimulation, has been used for 30 years, 16 but there remains a lack of consistent proof of e cacy and cost e ectiveness, and some studies 17,18 report the development of tolerance with resultant loss of analgesic e cacy.…”

Section: Introductionmentioning

confidence: 99%

The amelioration of the suffering associated with spinal cord injury with subperception transcranial electrical stimulation

et al. 2003

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Study design: Double blind, partial crossover. Objectives: To evaluate the analgesic activity of a novel cranial electrostimulus in people with spinal cord injury (SCI). Setting: Hereward College, a residential centre that provides educational facilities for students with disabilities. Methods: Subjects with SCI experiencing chronic pain were randomly assigned into two groups, one of which received sham and the other transcranial electrostimulation treatment (TCET) on two occasions daily for four successive days. After a`wash-out' period of 8 weeks all subjects returned and received the identical stimulus that the treated cohort received on the ®rst arm of the study. Results: Pain measurements applied before and after each session indicated that the pain decreased in the treated group to 51% of that reported at the commencement of treatment; reported pain intensity did not decrease signi®cantly in the sham treated subjects. The same (sham) subject group reported experiencing 59% of the pain at the end of the second arm of the study (TCET) as on the ®rst arm (sham). No signi®cant di erences were determined between the mood of all subjects estimated before and after each sham or TCET treatment session. The reported analgesic, and combined antidepressant and anxiolytic drug use in subjects receiving TCET on the second arm of the study, was 46% and 53% respectively of the average pre-study drug use. No similar decrease in the use of the drugs was noted in the same subjects after sham treatment on the ®rst arm of the study. Salivary cortisol determinations made prior to and after each sham and treatment session implicated this corticoid in the pain-relieving mode of action of the treatment, but could not be associated with any changes in mood. Subjects receiving TCET had signi®cantly higher urinary 3-methoxy-4-hydroxy-phenylglycol (MHPG) output after the TCET treatment period than sham stimulation, implicating increased central noradrenaline (NA) metabolism in the observed e ects. Conclusion: The subjects reported less pain during, and immediately after receiving this transcranial treatment, although they were using less medication than when receiving sham treatment.

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Section: Introductionmentioning

confidence: 99%

The amelioration of the suffering associated with spinal cord injury with subperception transcranial electrical stimulation

et al. 2003

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“…Another theory involves the release of endogenous opioids or other neurotransmitters by stimulation of the spinal cord [5,8,10]. This opioid theory is less likely, as it has been shown that naloxone does not reverse the effects of SCS [11].…”

Section: Mechanism Of Actionmentioning

confidence: 97%

“…Thus, both of these neurotransmitters may have a role in pain relief afforded by SCS. Other neurotransmitters, such as gammaaminobutyric acid, noradrenaline, and glycine, have also been shown to increase in the dorsal horn after SCS and may play a role in the relief of pain [5].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

“…A novel approach of stimulation of the spinal cord for the relief of chronic pain by Shealy et al [1] in 1967 was a much-welcomed therapeutic option. However, the mid1970s experienced a decrease in its use secondary to the lack of patient selection criteria and objective methods of evaluation, indiscriminate widespread use, and early technical problems [2][3][4][5]. Even Shealy [1] quit implanting spinal cord stimulators in 1974 [6].…”

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confidence: 99%

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Neuromodulation: Spinal cord and peripheral nerve stimulation

Day

2000

Current Review of Pain

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Spinal cord and peripheral nerve stimulation for relief of chronic intractable pain have been used since the mid-1960s. Multiple mechanisms of action have been theorized without a clear-cut winner. The early frustrations with patient selection criteria and equipment difficulties have diminished secondary to carefully controlled studies and improvements in equipment designs. Efficacy studies consistently show an overall 50% improvement in long-term pain control in patients who have failed conservative or other invasive modalities. With improvements in today's technology, one hopes that better analgesia will be attainable.

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“…For several years neurostimulation devices have been used to treat various chronic pain syndromes shown to be intractable to other treatment modalities. Neurostimulation has been performed in neural structures in and outside the CNS, and encompasses various techniques such as transcutaneous electrical nerve stimulation, peripheral nerve stimulation, spinal cord stimulation, deep brain stimulation and cortical stimulation [22][23][24][25] . Spinal cord stimulation is described as being effective in the treatment of neuropathic pain syndromes such as reflex sympathetic dystrophy, peripheral nerve injury, postamputation pain, spinal cord lesions, and ischemic pain syndromes as seen in angina pectoris and peripheral vascular disease [26,27] .…”

Section: Introductionmentioning

confidence: 99%

Long-Term Evaluation of Treatment of Chronic, Therapeutically Refractory Tinnitus by Neurostimulation

Bartels¹,

Staal²,

Holm³

et al. 2007

Stereotact Funct Neurosurg

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Objective: Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by means of chronic electrical stimulation of the vestibulocochlear nerve. Patients: Inclusion criteria were severe, chronic, therapeutically refractory, unilateral tinnitus and severe hearing loss at the ipsilateral site. Out of 6 patients, 4 patients were selected for long-term evaluation. Two patients were not evaluated because of premature dropout. Material and Methods: A stimulation electrode was placed around the vestibulocochlear nerve through a retrosigmoid approach and connected to a subcutaneously positioned pulse generator via an extension cable. Follow-up was performed 3 months and 42.5 months after implantation. Three measures for treatment outcome were used. First, effect sizes were determined by means of the total Tinnitus Handicap Inventory (THI) score using Cohen’s formula. Second, general and tinnitus-specific audiometric tests were performed in on and off conditions of the neurostimulation system. Third, recordings were noted for tinnitus severity and treatment success on a visual analogue scale. Results: All 4 patients reported successful treatment with neurostimulation. The effect size after 3 months was 0.7, indicating an average effect, while the effect size measured during long-term follow-up was 1.75, indicating a substantial effect with major clinical implications. No changes in hearing level for both ears were measured. The neurostimulation system did not change the tinnitus pitch in any of the patients, and resulted in a minimal reduction of tinnitus loudness in only 2 patients. In all 4 patients the original tinnitus sound was replaced by another, pleasantly perceived sound. The average VAS score of perceived tinnitus severity was reduced from 8 to 3.25. The average VAS score for treatment success was 7.25. Conclusions: The long-term follow-up of neurostimulation treatment for chronic tinnitus shows promising results. Long-term results were better than those determined after a 3-month follow-up. In all patients the tinnitus was replaced by another sound, which was perceived as pleasant. Further studies are needed before accepting neurostimulation as a treatment modality for chronic, therapeutically refractory tinnitus.

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Spinal cord stimulation in chronic pain syndromes

Cited by 31 publications

References 48 publications

The amelioration of the suffering associated with spinal cord injury with subperception transcranial electrical stimulation

The amelioration of the suffering associated with spinal cord injury with subperception transcranial electrical stimulation

Neuromodulation: Spinal cord and peripheral nerve stimulation

Long-Term Evaluation of Treatment of Chronic, Therapeutically Refractory Tinnitus by Neurostimulation

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