Chapter 27 - Spinal Cord Stimulation for Painful Neuropathies

Abstract

This chapter focuses on the use of spinal cord stimulation (SCS) for painful neuropathies. The mechanisms underlying the relief of neuropathic pain of peripheral origin by SCS are poorly understood. One common manifestation of peripheral neuropathy is pain. The pain of peripheral neuropathy is often characterized as burning in quality, with occasional shooting electrical-like sensations and is accompanied by loss of sensation and paresthesiae. The pain can become severe and can be the main presenting symptom or the only symptom of the neuropathy. Neurostimulation traditionally has a limited but important role in the management of neuropathic pain that has been refractory to medical treatment. Neurostimulation for painful peripheral neuropathies has taken the form of either spinal cord stimulation or peripheral nerve stimulation. SCS may provide a suppressive action on dorsal horn neuronal hyperexcitability, which is associated with signs of peripheral neuropathy. The suppressive effect of SCS on tactile allodynia presumably corresponds to a normalization of the excitability of wide dynamic range neurons (WDRN) in response to innocuous stimuli. One component in the pain relieving effects of SCS may result from induction of increased GABA release, thereby also suppressing the exaggerated excitatory amino acids activity, possibly through activation mainly of the GABAb receptors.