Neuromodulation : journal of the International Neuromodulation Society
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For more than a decade, spinal cord stimulation (SCS) has been used as an adjuvant treatment for patients who are unresponsive to conventional therapies for angina pectoris. Many studies showed that SCS has both electro-analgesic and anti-ischemic effects. Nonetheless, the biological substrates by which SCS acts have not yet been unraveled, although recently areas in the brain have been described that show changes in blood flow, following SCS, and during provocation of angina. ⋯ In conclusion, the rat model we developed appears to be suitable for studying potential mechanisms through which SCS may act. In addition, SCS affects c-fos expression in specific parts of the brain known to be involved in regulation of pain and emotions. HSP72-expression is limited to the endothelium of certain parts of the CNS and thereby excludes physical stress effects as a potential mechanism of SCS.
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Epidural spinal cord stimulation (SCS) has gained a secure place in the armamentarium of the surgeon treating chronic pain conditions (1, 2). The complexity of the intraspinal structures and their different susceptibility to electrical signals, however, has made it difficult to characterize the effects of the stimulation, Some important recent work has helped shed light on the electrical properties of the intraspinal structures and on the electrical field potentials generated with epidural spinal cord stimulation. This work, initially pioneered by Sin and Coburn, has successfully been expanded and perfected by Holsheimer and Strujik at the University of Twente, The Netherlands (3-8). ⋯ The model can simulate the effects of epidural stimulation with different electrode geometries and configurations (8). The data generated from the model were then validated by comparing them to a large number of data collected by the author in implanted subjects (9-12). The author also conducted a detailed analysis of the clinical properties of the activation of the intraspinal structures at various electrode positions in the spine (13, 14).