scholarly journals Supraspinal Mechanisms of Spinal Cord Stimulation for Modulation of Pain

2019 ◽  
Vol 130 (4) ◽  
pp. 651-665 ◽  
Author(s):  
Eellan Sivanesan ◽  
Dermot P. Maher ◽  
Srinivasa N. Raja ◽  
Bengt Linderoth ◽  
Yun Guan
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Neurologic Diseases ◽  
Beneficial Effects ◽  
Chronic Pain Treatment ◽  
Sites Of Action ◽  
Pain Inhibition

Abstract The field of spinal cord stimulation is expanding rapidly, with new waveform paradigms asserting supraspinal sites of action. The scope of treatment applications is also broadening from chronic pain to include cerebral ischemia, dystonia, tremor, multiple sclerosis, Parkinson disease, neuropsychiatric disorders, memory, addiction, cognitive function, and other neurologic diseases. The role of neurostimulation as an alternative strategy to opioids for chronic pain treatment is under robust discussion in both scientific and public forums. An understanding of the supraspinal mechanisms underlying the beneficial effects of spinal cord stimulation will aid in the appropriate application and development of optimal stimulation strategies for modulating pain signaling pathways. In this review, the authors focus on clinical and preclinical studies that indicate the role of supraspinal mechanisms in spinal cord stimulation–induced pain inhibition, and explore directions for future investigations.

Problematic Prescription Opioid Use in a Chronic Pain Treatment Facility: The Role of Emotional Processes

2018 ◽  
Vol 54 (3) ◽  
pp. 495-505 ◽  
Author(s):  
Lindsay M. S. Oberleitner ◽  
Mark A. Lumley ◽  
Emily R. Grekin ◽  
Kathryn M. Z. Smith ◽  
Amy M. Loree ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Treatment Facility ◽  
Emotional Processes ◽  
Chronic Pain Treatment ◽  
Prescription Opioid Use

Spinal cord stimulation in management of chronic pain

1989 ◽  
Vol 70 (4) ◽  
pp. 519-524 ◽  
Author(s):  
Mario Meglio ◽  
Beatrice Cioni ◽  
Gian Franco Rossi
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Spinal Cord Lesion ◽  
Post Herpetic Neuralgia ◽  
Herpes Zoster Infection ◽  
Content Type ◽  
Back Surgery

✓ Between 1978 and 1986, 109 patients with chronic pain underwent spinal cord stimulation (SCS) at the authors' institute as part of their pain treatment program. The results of SCS in these patients at the end of the test period and at the latest follow-up examination are analyzed in relation to the etiology of their pain. In 40 patients pain was associated with an obstructive peripheral vasculopathy, in 10 with a previous herpes zoster infection, in 15 with an incomplete traumatic spinal cord lesion, in nine with root and/or nerve damage, in 11 with cancer, and in 19 with previous back surgery. The etiology of the pain in five patients was uncertain. This experience supports the conclusion that the best indications for SCS are vasculopathic pain and post-herpetic neuralgia. No clinical usefulness was found for SCS in cancer pain or in central deafferentation types of pain.

Psychological factors in spinal cord stimulation therapy: brief review and discussion

2006 ◽  
Vol 21 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Daniel M. Doleys
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Psychological Factors ◽  
Low Back ◽  
Psychological Variables ◽  
Psychological Screening ◽  
What Works ◽  
Made In

✓Since its introduction in 1967 by Shealy and colleagues, spinal cord stimulation (SCS) therapy has become an accepted approach to the treatment of certain types of chronic pain. Significant advances have been made in surgical technique, hardware technology, and the variety of disorders for which SCS has proven to be potentially beneficial. Despite these advancements, 25 to 50% of patients in whom a preimplantation trial screening yields successful results report loss of analgesia within 12 to 24 months of implantation, even in the presence of a functioning device. Psychological factors may play an important role in understanding this observation and improving the outcomes. In this article the author briefly reviews some of the data on psychological factors potentially involved in SCS. Research on patients with low-back and extremity pain was more heavily relied on because this is the population for which the most data exist. The discussion is divided into four sections: 1) role of psychological factors; 2) psychological screening and assessment; 3) patient selection and psychological screening; and 4) psychological variables and outcomes. To date, the data remain speculative. Although few definitive conclusions can be drawn, the cumulative existing experience does lend itself to some reasonable recommendations. As with all therapies for chronic pain, invasive or noninvasive, the criteria for success and an acceptable level of failure need to be established, but remain elusive. The emphasis herein is to try to take what works and make it work better.

The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment

2015 ◽  
Vol 33 (3) ◽  
pp. 308-324 ◽  
Author(s):  
Katie Smith ◽  
Michael Herman ◽  
Christopher Smith
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Chronic Pain Treatment

Chronic Pain Following Spinal Cord Injury: The Role of Immunogenetics and Time of Injury Pain Treatment

2014 ◽  
Author(s):  
Mark Hutchinson ◽  
Janet Coller ◽  
Jillian Clark ◽  
Ruth Marshall ◽  
James Middleton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Pain Treatment ◽  
Cord Injury

scholarly journals Neurovascular Unit in Chronic Pain

2013 ◽  
Vol 2013 ◽  
pp. 1-18 ◽  
Author(s):  
Beatrice Mihaela Radu ◽  
Placido Bramanti ◽  
Francesco Osculati ◽  
Maria-Luisa Flonta ◽  
Mihai Radu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Neurovascular Unit ◽  
Socioeconomic Impact ◽  
Pain Mechanisms ◽  
Analgesic Drugs ◽  
Pain Models ◽  
Chronic Pain Treatment ◽  
Blood Spinal Cord Barrier

Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU) has been recently proposed. In particular, the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB), two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment.

scholarly journals Importance of Axial Migration of Spinal Cord Stimulation Trial Leads with Position

2013 ◽  
Vol 6;16 (6;11) ◽  
pp. E763-E768 ◽  
Author(s):  
Chong H. Kim
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Small Sample ◽  
X Rays ◽  
Trial Period ◽  
Postural Change ◽  
Postural Changes

Background: Spinal cord stimulation (SCS) is an established treatment option for chronic pain. Prior to permanent implantation, temporary trials are performed to evaluate the SCS treatment. During the trial period, it is common for the patients to experience changes in paresthesias. However, it is unclear what the role of lead migration is, if any, in the changes in paresthesia. Objective: To evaluate the role of lead migration on the effect of postural stimulation changes during SCS trials. Study Design: Case series. Setting: University pain management center. Methods: X-rays of the patients with successful trials, in sitting and standing position, were obtained at the end of a 7 day SCS trial. Data were collected based on the need for adjustment of the stimulation settings due to changes in paresthesias with postural change of sitting versus standing. Results: The average lead migration was 3.05 mm inferiorly from a standing to sitting position for all subjects. The average migration was 2.85 mm in subjects requiring adjustment of the SCS setting due to change in paresthesia compared to 3.24 mm for those who did not require adjustment regardless of position. The results were insignificant based on P = 0.17. Limitations: Small sample size, case series. Conclusions: This case series demonstrates continued support for the role of the width of the cerebral spinal fluid space as the significant factor on paresthesia changes in SCS with respect to postural changes, even during the trial period. Key words: Spinal cord stimulation, postural change, lead migration, paresthesia, neurostimulation, chronic pain, dorsal column

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