Spinal cord stimulation (SCS) delivers electrical currents to the dorsal spinal cord to treat chronic pain.
SCS involves:
- Implanted electrodes
- Dorsal column stimulation
- Gate control modulation
- Multiple waveforms
- Lamina I-II pain transmission
- Wide dynamic range neurons
- Central sensitization
¶ Dorsal Column
- Large-fiber activation
- A-beta fibers
- Gate control
- Ventral posterolateral nucleus
- Pain relay
- Sensory integration
- Large fiber activation
- Inhibits small fibers
- Reduces pain signal
- Periaqueductal gray
- Raphe magnus
- Endogenous opioids
- GABA modulation
- Glutamate changes
- Serotonin
- Most common indication
- Leg pain relief
- Improved function
- CRPS
- Upper/lower extremity
- Variable response
- Peripheral vascular disease
- Angina
- Visceral pain
- Diabetic neuropathy
- Post-herpetic neuralgia
- Central pain
- Low-frequency
- Paresthesias
- Standard therapy
- 10kHz
- No paresthesias
- Recent advance
- Intermittent pulses
- Better pain relief
- Less tolerance
- SCS mechanisms (2022)
- SCS for chronic pain (2021)