Integrative approaches in spinal cord stimulation: Neuropathic pain management and motor recovery in spinal cord injury. A narrative review

Brain and Spine, 2024 · DOI: https://doi.org/10.1016/j.bas.2024.102781 · Published: March 14, 2024

Simple Explanation

Spinal cord stimulation (SCS) is a common treatment for long-lasting nerve pain from various conditions. New and improved technologies have been developed recently to make neuromodulation more effective for patients who don't respond to medication. SCS is based on the idea that activating large nerve fibers in the spinal cord can block pain signals from reaching the brain. Recent studies suggest SCS also affects the brain's pain control pathways. Newer stimulation methods, like burst and high-frequency stimulation, aim to provide better pain relief with fewer side effects. Advances in electrode technology allow for targeting larger pain areas.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5, Narrative Review

Key Findings

1
Proper patient selection is crucial for achieving the best outcomes with spinal cord stimulation for neuropathic pain.
2
Innovative stimulation techniques like burst and high-frequency stimulation may reduce the risk of paresthesias compared to traditional stimulation.
3
Spinal cord stimulation shows potential in enabling the recovery of gait functions in spinal cord injury patients by modulating spinal networks.

Research Summary

Spinal cord stimulation (SCS) is a widespread treatment for chronic neuropathic pain originating from different causes, particularly failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). Proper selection of the patient is of paramount importance to achieve the best results from this specific neuromodulation treatment. Regarding the different types of stimulation patterns, no definite evidence-based guidelines exist on the most appropriate approach in relation to the specific type of neuropathic pain. Novel protocols of stimulation (burst stimulation and high frequency stimulation) may improve the trade-off between therapeutic benefits and potential side effects. Likewise, decreasing the rates of hardware-related complications will be also useful to increase the application of neuromodulation in clinical settings.

Practical Implications

Improved Pain Management

Novel SCS protocols offer a better balance between therapeutic benefits and reduced side effects, potentially enhancing pain management.

Enhanced Motor Recovery

SCS has potential for enabling gait function recovery in spinal cord injury, suggesting new avenues for rehabilitation.

Wider Clinical Application

Reducing hardware-related complications can increase the adoption of neuromodulation in clinical settings, improving patient outcomes.

Study Limitations

1
Lack of evidence-based guidelines for specific stimulation patterns in relation to neuropathic pain types.
2
Underutilization of SCS despite its proven efficacy, safety, and cost-effectiveness.
3
Need for long-term follow-up studies for larger case series of patients using burst stimulation and high-frequency stimulation.

Your Feedback

Was this summary helpful?

Back to Neurology