Abstract
sia. Mechanism of Action: SCS works in multiple domains Neurochemical effects: There is no relation between SCS and opioid release, there is an increase dorsal horn GABA expression seen in animal model after SCS stimulation, levels of Substance P and serotonin are shown to be elevated by SCS. Studies have proven that excitatory amino acid release is suppressed by SCS via action on GABA-B receptors and intra-thecal adenosine as well baclofen may potentiate the effect of SCS. The net effect of these neurochemical effects reduces dorsal horn neuronal excitability [3]. Neurophysiological effects: SCS application modulates nociceptive response via an action on abnormal pain-mediating Abeta fibre function. The response of wide dynamic range of neurons (WDR) to chemical, thermal and mechanical stimuli in animal neuropathic models has shown suppression with application of SCS. Various models have shown specific role played by remote nervous system like anterior pretectal nucleus which modulates the descending pain inhibitory pathways due to SCS stimulation [3]. Cardiac/Vascular effects: In angina pectoris, SCS has been demonstrated to reduce noxious input to pain pathway, inhibit the afferent sympathetic nervous system and stabilize intra-cardiac neuronal activity. In ischemic pain models SCS is associated with peripheral vasodilation, mediated via the release of calcitonin gene-related peptide (CGRP).
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