Spinal Cord Stimulation and Treatment of Peripheral or Central Neuropathic Pain: Mechanisms and Clinical Application

Neural Plasticity, 2021 · DOI: https://doi.org/10.1155/2021/5607898 · Published: October 21, 2021

Simple Explanation

Spinal cord stimulation (SCS) is a treatment used for peripheral neuropathic pain, but its use for spinal cord injury-induced central neuropathic pain is still under investigation. This paper reviews how SCS works to relieve pain and its use in treating both peripheral and central neuropathic pain. SCS is believed to work by preventing pain signals from traveling to the brain, enhancing the body's own pain-reducing systems, and activating brain areas that deal with pain and emotions. While SCS is approved for peripheral neuropathic pain conditions, more research is needed to understand how it relieves central neuropathic pain before it can be widely used for spinal cord injury patients.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
SCS modulates nociceptive processing by inhibiting ascending nociceptive transmission via GABA and endocannabinoids, facilitating descending inhibition by releasing noradrenalin, dopamine, and serotonin, and activating supraspinal brain areas related to pain perception and emotion.
2
Conventional SCS directly stimulates large-diameter nonnociceptive Aβ-fibers in the dorsal column, inhibiting nociceptive signals entering the spinal dorsal horn and activating supraspinal pain processing systems.
3
SCS not only alleviates pain but also reduces negative emotional processing of pain by modulating cortical connectivity between the somatosensory cortex and limbic areas.

Research Summary

The analgesic mechanisms of SCS are gradually unveiled with the involvement of the “Gate control” theory, segmental inhibition, the descending inhibitory system, and cortical modulation. It is recommended for selected indications related to PNP-like patients who experience refractory pain including CRPS and FBSS. SCS may be considered as a potential therapy to treat trauma-induced CNP in patients, whereas SCI due to degenerative pathologies and somatic infection is a contraindication of SCS.

Practical Implications

Clinical Application for PNP

SCS is an effective treatment option for peripheral neuropathic pain conditions such as CRPS, FBSS, diabetic neuropathy, ischaemic pain, and postherpetic neuralgia, although efficacy varies with the specific clinical indication.

Potential Use for CNP

SCS shows promise for treating central neuropathic pain, particularly in trauma-induced SCI, but further research is needed to establish its benefits and safety for this condition.

Optimizing SCS Therapy

Understanding the mechanisms of SCS-induced pain relief, including segmental inhibition, descending inhibitory systems, and cortical modulation, may lead to more effective and accurate use of SCS for chronic pain relief.

Study Limitations

1
Mechanisms underlying SCS-induced pain relief are still not fully understood.
2
Risk of complications of SCS due to lead infection and dislocation is unneglectable.
3
Studies on CNP and SCS are based on experimental contusion/transection-induced SCI pain models.

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