Managing chronic pain is one of modern medicines greatest challenges. Pain that is severe, persistent and unresponsive to drugs or surgery can be daunting and debilitating for patients and their families. Spinal cord stimulation (SCS) offers a viable treatment alternative that has proven to be both clinically and cost effective in properly selected patients.
Electrical stimulation is presently the most widespread application of all available neuromodulation modalities. The large myelinated fibers of the dorsal column/medial lemniscal (DCML) system are targeted for stimulation. Components of this system include: peripheral nerves, dorsal roots (including sacral), dorsal columns, medial lemniscus, thalamus, and cortex, all of which are appropriate physiological targets for stimulation. The DCML system mediates the following somatic sensations: touch, limb position sense, and vibration. It is speculated that the tingling (vibratory) sensation felt with stimulation paresthesia is the mechanism which inhibits the chronic pain signaling system.
In the present discussion, we will focus primarily on stimulation of the dorsal columns of the spinal cord. This will include a historical review, an explanation of our current understanding of the mechanisms of action, a summary of treatable disease states, a mention of where this technology is today, and a look into the future of neurostimulation.
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