Spinal cord stimulation for neuropathic pain |
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| Affiliation: | 1. Department of Neurosurgery, CHU de Nice, Université Cote d’Azur, Nice, France;2. Université Cote d’Azur, FHU INOVPAIN, CHU de Nice, Nice, France;1. Department of neurology, university hospital of Besançon, 3, boulevard, Alexandre-Fleming, 25030 Besançon, France;2. Clinical and integrative neuroscience, research laboratory 481, Bourgogne Franche-Comté University, Besançon, France;3. Inserm, département de neurologie, CRC sclérose en plaques, université de Montpellier, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France;4. UNIROUEN, Inserm U1245, department of neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen university hospital, Normandie university, 76000 Rouen, France;1. Department of Medicine, University of Joinville Region, Joinville, Brazil;2. Department of Intraoperative Monitoring – Neurological and Neurosurgical Clinic of Joinville, Brazil;3. Department of Neurosurgery – Neurological and Neurosurgical Clinic of Joinville, Brazil;1. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;2. Department of Neurosurgery, Vicki and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;1. Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA;3. Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA;2. Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA;1. Department of Neurosurgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA;2. Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA;1. Department of Neurosurgery, Albany Medical College, Albany, NY, United States;2. Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States |
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| Abstract: | Spinal cord stimulation (SCS) is used for more than 40 years to treat localized chronic medically refractory neuropathic pain involving limb(s) and trunk. The most frequent indications remain complex regional pain syndrome (CRPS) failed back surgery syndrome (FBSS), and peripheral neuropathy. Stimulation-induced paresthesias, perceived by the patient, prevent blinded evaluation and increase the placebo effect, decreasing the credibility of the tonic SCS efficacy. Retrospective studies reported that about 50% of the patients are improved more than 50% at short-term, but long-term improvement is less. Several comparative randomized trials (RCT) are now available. In CRPS, a RCT demonstrated the superiority of SCS plus physiotherapy compared to physiotherapy alone. In FBSS, two RCTs have shown that SCS was superior to reoperation and conventional medical treatment, (CMM) respectively. New stimulation waveforms, namely burst, high frequency (10 KHz) stimulation and close-loop SCS, have been proposed recently to avoid the perception of paresthesias and/or increase the pain relief. RCTs in FBSS have suggested that these new SCS modalities were as least as efficient than conventional tonic SCS and perhaps slightly superior. Two RCTs confirmed SCS efficacy in painful diabetic neuropathy in comparison with CMM. Complications are frequent (hardware dysfunction or migration, superficial infection) but exceptionally serious. Consequently, the risk/benefit ratio is favorable to SCS, considering that chronic pain patients undergoing this procedure are usually resistant to all the other therapies. |
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| Keywords: | Spinal cord stimulation Neuromodulation Neuropathic pain Chronic pain Review |
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