postsynaptic dorsal column epidural stimulation

High-frequency spinal cord stimulation for the treatment of chronic back pain patients: results of a prospective multicenter European clinical study.

Van Buyten JP, Al-Kaisy A, Smet I, et al. Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study. Historical and present state of neuromodulation in chronic pain. History of electrical neuromodulation for chronic pain. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Electrical inhibition of pain: experimental evaluation. Shealy CN, Taslitz N, Mortimer JT, et al. New York: Springer Science+Business Media 2005. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the neuromodulation appropriateness consensus committee.

Mechanisms and models of spinal cord stimulation for the treatment of neuropathic pain. Experimental spinal cord stimulation and neuropathic pain: mechanism of action, technical aspects, and effectiveness. Smits H, van Kleef M, Holsheimer J, et al. Technological advances in lead design, battery efficiency, and pulse programming, in combination with properly designed randomized clinical trials, will continue to make SCS an effective alternative therapy for chronic painful conditions. There is also evidence of positive outcomes for treating neuropathies, abdominal/pelvic pain, and ischemic-related pain syndromes. Best levels of evidence support SCS efficacy in low back pain indications such as failed back surgery syndrome (FBSS), as well as in complex regional pain syndromes (CRPS). SCS is a minimally invasive therapy that has proven to be effective for the treatment of chronic neuropathic pain in which conservative management has failed. Recent stimulation paradigms (HF, burst) have shown to be clinically effective without the need for paresthesias, implying that the stimulating electrical field modulates pain signals via alternative mechanisms. Electrical current can be adjusted to stimulate and induce paresthesias in large fibers of the dorsal columns, in turn closing the gate to the nociceptive fibers transmitting input to the brain. Conventional SCS uses electrical pulses delivered at relatively low frequency (~50 Hz) using array designs that can be customized to patient needs. The term spinal cord stimulation (SCS) describes the electrical stimulation of the dorsal column via electrode arrays implanted in the epidural space of a spinal level associated with a painful dermatome.

Postsynaptic dorsal column epidural stimulation