Mechanisms and mode of action of spinal cord stimulation in chronic neuropathic pain.

Mechanisms and mode of action of spinal cord stimulation in chronic neuropathic pain. Postgrad Med. 2020 May 13;: Authors: Heijmans L, Joosten EA Abstract Tonic spinal cord stimulation (SCS) has been used as a treatment for chronic neuropathic pain ever since its discovery late 1960's. Despite its clinical successes in a subset of chronic neuropathic pain syndromes, several limitations such as insufficient pain relief and uncomfortable paresthesias, have led to the development of new targets, the dorsal root ganglion, and new stimulation waveforms, such as burst and high frequency. The aim of this review is to provide a brief overview of the main mechanisms behind the mode of action of the different SCS paradigms. Tonic SCS mainly acts via a segmental spinal mechanism where it induces GABA-release from inhibitory interneurons in the spinal dorsal horn. Tonic SCS concurrently initiates neuropathic pain modulation through a supraspinal-spinal feedback loop and serotonergic descending fibers. Mechanisms of stimulation of the DRG as well as those related to new SCS paradigms are now under investigation, where it seems that burst SCS not only stimulates sensory, discriminative aspects of pain (like Tonic-SCS) but also emotional, affective and motivational aspects of pain. Initial long-term study results on closed-loop SCS systems hold promise for improvement of future SCS treatment. PMID: 32403963 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research

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Source: Local and Regional Anesthesia - Category: Anesthesiology Tags: Local Reg Anesth Source Type: research
Conditions:   Low Back Pain;   Pain Measurement;   Chronic Pain;   Analgesia, Epidural;   Clinic, Pain Interventions:   Procedure: Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.;   Procedure: Fluoroscopically guided lumbar facet joint injection.;   Procedure: Fluoroscopically guided lumbar epidural corticosteroid injection.;   Procedure: Fluoroscopically guided caudal epidural c orticosteroid injection.;   Procedure: Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.;   Procedu...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
AbstractObjectivesTraumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology.Materials and MethodsTwenty ...
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Clinical Research Source Type: research
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Source: La Radiologia Medica - Category: Radiology Source Type: research
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Source: Pain - Category: Anesthesiology Tags: Research Paper Source Type: research
BackgroundDorsal root ganglion stimulation (DRG ‐S) is a novel approach to treat chronic pain. Lead placement at L2 has been reported to be an effective treatment for axial low back pain (LBP) primarily of discogenic etiology. We have recently shown, in a diverse cohort including cases of multilevel instrumentation following extensive prior bac k surgeries, that DRG‐S lead placement at T12 is another promising target. Local effects at the T12 DRG, alone, are insufficient to explain these results.Materials and MethodsWe performed a literature review to explore the mechanisms of LBP relief with T12 DRG ‐S.FindingsBranc...
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Review Article Source Type: research
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Source: Brain, Behavior, and Immunity - Category: Neurology Authors: Tags: Brain Behav Immun Source Type: research
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Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Clinical Research Source Type: research
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Source: Journal of Neurochemistry - Category: Neuroscience Authors: Tags: ORIGINAL ARTICLE Source Type: research
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Source: Pain Research and Management - Category: Anesthesiology Authors: Tags: Pain Res Manag Source Type: research
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