• Keita Fukazawa and Toyoshi Hosokawa.
• Department of Pain Treatment and Palliative Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-8566.
• Masui. 2009 Nov 1;58(11):1393-400.

AbstractSpinal cord stimulation (SCS) is an established treatment for intractable neuropathic pain. SCS is performed using an implantable pulse generator connected to leads with electrodes positioned in the dorsal epidural space, which are then used to stimulate the ascending and descending dorsal column fibres to achieve paresthesia covering the area of pain. It is based on the Gate Control Theory, introduced by Melzack and Wall in 1965, which suggests that stimulation of large afferent fibres can inhibit pain transmission at the level of the dorsal horns. More recent studies indicate that SCS releases substance P serotonin, noradrenaline and GABA in the dorsal horns; activation of the GABAB receptor may be linked to a decrease in the release of glutamate and other excitatory amino acids, resulting in a decrease of neuropathic pain. The clinical indications for SCS are mainly peripheral vascular diseases (PVD), refractory angina, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS) type 1 and type 2, spinal cord stenosis and neuropathic pain. The new puncture trial method is less invasive and can reduce psychological resistance of the patient for SCS manipulation.

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