Spinal cord stimulation: A brief update on mechanisms of action

Abstract

Spinal cord stimulation (SCS) originated from the gate control theory by Melzack and Wall some 40 years ago and is now widely practised as a therapy in neuropathic pain of peripheral origin. The physiological mechanisms behind the beneficial effects however are hitherto only fragmentarily known. In this short review the present knowledge is updated with recent data from animal experiments and from clinical observations. SCS used for neuropathic pain and for ischemic seems to utilize fundamentally different mechanisms and in the latter syndromes the primary effect seems to be reduction of tissue ischemia. In neuropathic pain, in contrast, the neuronal pain-generating mechanisms are directly targeted but the investigated networks are complex and much research on these matters is needed in order to further develop spinal neuromodulation for treatment-refractory pain syndromes.