Abstract
This chapter focuses on the use of spinal cord stimulation (SCS) in neuropathic and ischemic pain syndromes. SCS has long been utilized for neuropathic pain of peripheral origin, in ischemic pain states, e.g. peripheral arterial occlusive disease and in vasospastic conditions, and in angina pectoris. SCS may induce effects in multiple organ systems and the benefit for a certain condition may depend on the site of spinal cord activated and the relevance of the released transmitters and other neuronal changes for a certain painful syndrome. It is effective in some pain syndromes that are otherwise resistant to other treatments, and it is well tolerated by patients, is minimally invasive, is reversible and, when compared to chronic pharmacotherapies, has fewer adverse effects. In some syndromes, SCS can also lead to the improvement of organ function, resulting in reduction of pain and other uncomfortable symptoms associated with the disease. In pain syndromes with signs of autonomic disturbance, SCS may hypothetically act on the symptoms through a direct inhibitory action onto central hyperexcitable neurons, by decreasing sympathetic efferent output acting on the sensitized adrenoreceptors on the damaged sensory neurons, and by reducing peripheral ischemia both by a sympaticolytic action and via antidromic mechanisms.
Published Version
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