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<a href="http://doi.org/10.1186/s42234-019-0023-1" target="_blank" rel="noreferrer noopener">http://doi.org/10.1186/s42234-019-0023-1</a>
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5
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Title
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Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action
Publisher
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Bioelectronic Medicine
Date
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2019
2019-06
Subject
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Biomarker; Chronic pain; Complex regional pain syndrome; Failed back surgery syndrome; Mechanisms of action; Neuroinflammation; Neuropathic pain; Neurophysiology; Objective measures; Spinal cord stimulation
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Caylor Jacob; Reddy Rajiv; Yin Sopyda; Cui Christina; Huang Mingxiong; Huang Charles; Ramesh Rao; Baker Dewleen G; Simmons Alan; Souza Dmitri; Narouze Samer; Vallejo Ricardo; Lerman Imanuel
Description
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Well-established in the field of bioelectronic medicine, Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. Despite advances in our understanding of SCS-mediated antinociception, there still exists limited evidence clarifying the pathways recruited when patterned electric pulses are applied to the epidural space. The rapid clinical implementation of novel SCS methods including burst, high frequency and dorsal root ganglion SCS has provided the clinician with multiple options to treat refractory chronic pain. While compelling evidence for safety and efficacy exists in support of these novel paradigms, our understanding of their mechanisms of action (MOA) dramatically lags behind clinical data. In this review, we reconstruct the available basic science and clinical literature that offers support for mechanisms of both paresthesia spinal cord stimulation (P-SCS) and paresthesia-free spinal cord stimulation (PF-SCS). While P-SCS has been heavily examined since its inception, PF-SCS paradigms have recently been clinically approved with the support of limited preclinical research. Thus, wide knowledge gaps exist between their clinical efficacy and MOA. To close this gap, many rich investigative avenues for both P-SCS and PF-SCS are underway, which will further open the door for paradigm optimization, adjunctive therapies and new indications for SCS. As our understanding of these mechanisms evolves, clinicians will be empowered with the possibility of improving patient care using SCS to selectively target specific pathophysiological processes in chronic pain.
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<a href="http://doi.org/10.1186/s42234-019-0023-1" target="_blank" rel="noreferrer noopener">10.1186/s42234-019-0023-1</a>
2019
Baker Dewleen G
Bioelectronic Medicine
Biomarker
Caylor Jacob
Chronic pain
Complex regional pain syndrome
Cui Christina
Department of General Surgery
Failed back surgery syndrome
Huang Charles
Huang Mingxiong
Lerman Imanuel
Mechanisms of action
Narouze Samer
NEOMED College of Medicine
Neuroinflammation
Neuropathic pain
Neurophysiology
Objective measures
Ramesh Rao
Reddy Rajiv
September 2019 Update
Simmons Alan
Souza Dmitri
Spinal cord stimulation
Vallejo Ricardo
Yin Sopyda