Spinal Cord Stimulation for Treating Chronic Pain

Le résumé fourni par la source

Although spinal cord stimulation (SCS) is not a cure, it offers significant pain relief, increased activity levels, and the promise of improved quality of life.1,2 There have been many exciting developments in pain management within the last year. For patients who found paresthesias, which have been typically associated with tonic SCS, to be painful—even intolerable—and for those who have developed tolerance to SCS, two revolutionary new treatments are proving to be tremendously successful in providing pain relief without paresthesias. These two modalities are burst stimulation and high-frequency stimulation. Burst stimulation offers SCS placement at higher levels of the spine and the use of alternative waveforms, in which neurons fire in bursts, followed by periods of dormancy, leading to pain reduction without painful paresthesias. In combination with conventional tonic stimulation, burst stimulation represents a comprehensive approach to effective pain management. In addition, there has been the development of closed-loop systems that allow the integration of feedback loops to permit optimization of stimulation parameters. New stimulation paradigms have been designed that incorporate information on body position and response to stimulation. The use of component miniaturization is ongoing. Development continues of magnetic resonance imaging–compatible SCS systems that allow magnetic resonance imaging scans of hips, shoulders, back, and elsewhere, without concern about lead heating, device damage, unintentional stimulation, and magnetic pull; and of battery-free SCS, which transmits energy wirelessly from an external unit. Recent developments in the field of SCS and devices and approaches of the future, although not curative, are expected to continue to significantly relieve pain and promote activity postoperatively, and also help those whose cause of pain cannot be identified, for better outcomes and improved quality of life.

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