Spinal cord stimulation a modality for chronic pain relief

Abstract

Spinal cord stimulation (SCS) has been used for chronic pam relief for more than 3 decades .An understanding of the indications for•this invasive therapy has beef} slow in coming and remains far from complete. This is due tC':))tnplcxity and heterogenecity of chronic pam syndromes and of patients, ir'ladequacy of 1i1ethods of assessment of outcorre which itself reflects our lack of understanding of chronic pain ,. unreliability and intlexibility of early hardware an,.d the late improvement in patient selection. ,o Several thousands :pinal cord• s.timulation systems are currently implanted annually all over the world, 4Cf% of these in the USA , often very successfully and with a low complication rate. •rhe majority arimplanted percutaneously and 111 the thoracic spine for lower body and lower limb pain; relatively few are implanted for upper limb pain. There is a large pool of patients with severe , distressing syndromes , responsive to SCS ,\vhich affect the upper limb , includinf: reflex sympathetic • dystrophy (RSD) and causalgia , brachial plexus damage , post amputation pain and vasospastic conditions .

. As electrodes become available that give reliable service Ill the mobile cervical pines ' relatively morof these peol Ie will be able to benefit frm SCS. The open surgical implantati m of the electrodes, ts at present supenor 111 the cervical spme because of the degree of security of locatio'h that is possibl . Ciivcn that more than 30 years ha•, c passed since scs was introduced , those applications in which its efficacy has been clearly demonstrated should become more widely accepted \Vhcrc its rdlc is less clearly defined, better methods of outcome

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