Update on Spinal Cord Stimulation for Chronic Pain

초록

Theoretical basis of the spinal cord stimulation (SCS) is well-known gate control theory for segmental pain suppression. Its general concept is to apply electrical stimulation to the large diameter afferents (producing paresthesia) in the dorsal columns of the spinal cord, which via the central collaterals connect to the “gating mechanisms” in the dorsal horns (DH), thereby inhibiting the pain transmission by smaller diameter afferents. Spinal cord stimulation is generally indicated for the chronic, disabling pain that is refractory to other types of treatments. Common clinical indications for SCS are those clinical pain syndromes associated with neuropathic pain such as failed back surgery syndrome, complex regional pain syndromes, cancer pain, and pain associated with spasticity. Other types of pain associated with tissue ischemia attributable to peripheral vascular disease and intractable angina pectoris appears to be the rewarding indication for spinal cord stimulation. Nowadays, there has been introduction of new hardwares and stimulation techniques based on extensive basic and clinical research such as rechargeable generators, multicolumn electrode leads, independent current delivery, percutaneously insertable paddle leads, long-range telemetry, self-adjustable stimulation, magnetic resonance imaging compatibility, and high with burst frequency stimulation. The purpose of this review is to introduce the new paradigm of spinal cord stimulation with up-to-dated knowledge on basic and clinical research with emphasis on new stimulation indications, techniques with new device, and new targets for the stimulation.

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