Spinal cord stimulation in the treatment of chronic pain: from evidence to clinical practice - part 1.

INTRODUCTION

Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system. Pharmacotherapy remains the primary treatment for this condition, although non-pharmacological modalities such as physical and psychological therapy are also recommended.

STATE OF THE ART: Due to the limited efficacy of conventional therapies, interventional modalities such as spinal cord stimulation (SCS) are increasingly used. Several theories have been formulated to explain the analgesic mechanism of SCS. These include the gate control theory, neurochemical and immunological mechanisms, synaptic plasticity, and cortical reorganization.

CLINICAL IMPLICATIONS: Clinical data were analyzed in a systematic review of the literature that identified eight systematic reviews with meta-analyses. Most of the meta-analyses indicate that SCS provides statistically superior outcomes compared with conventional therapy or placebo in terms of pain intensity, degree of disability, and quality of life. Safety was evaluated in one systematic review, in which the estimated risks of lead or wire displacement/breakage and infection were significantly higher in the SCS arm than in the conventional therapy arm.

FUTURE DIRECTIONS: The benefits of earlier implementation of SCS in the therapeutic regimen are becoming recognized. It is necessary to clearly define the role of SCS in the multidisciplinary treatment of patients with neuropathic pain.