Mechanisms of spinal cord stimulation in painful syndromes: Role of animal models

作者：Linderoth B; Foreman RD^*

来源：Pain Medicine, 2006, 7: S14-S26.

DOI：10.1111/j.1526-4637.2006.00119.x

• spinal cord stimulation
• animal
• neuropathic pain
• ischemic pain
• visceral dysfunction
• angina pectoris

Spinal cord stimulation (SCS) came into clinical practice as a direct spin-off from the "gate control theory." This therapy has been used to treat neuropathic pain of peripheral origin as well as ischemic pain states, vasospastic conditions, and therapy-resistant angina pectoris. The physiological mechanisms of action for SCS are slowly emerging but still are only fragmentarily understood.
This chapter will describe the research methods and basic studies used to explore these mechanisms in normal healthy animals, as well as the use of animal models exhibiting different neuropathic, vasculopathic, and other pathological conditions. Brief discussions will address human experimental and clinical studies. The results show that SCS is effective in some pain syndromes otherwise resistant to treatment.
The mechanisms of SCS differ between the pathologies treated; in neuropathic pain, stimulation-induced suppression of central hyperexcitability seems pivotal, while in ischemic pain, inhibition of sympathetic outflow and in particular antodromic vasodilation are important mechanisms. Depending on where along the neuro-axis SCS is applied, stimulation can be used to control autonomic and viscero-somatic reflex activity involved in a certain syndrome, thereby alleviating the disease symptoms. Additionally, SCS may have its primary effect on improving organ function and could also reduce pain associated with the disease. SCS is a therapy that is safe, minimally invasive, reversible, and has few side effects compared with chronic pharmacotherapy. We firmly believe that SCS at present is an underused treatment modality. Furthermore, our society demands "evidence-based" and "mechanism-based" therapies. This demand amplifies the need to expand our knowledge through research projects aimed at further exploration of physiological mechanisms that are activated using neurostimulation. The results of these studies will lead to improvement and expansion of future neuromodulation therapies that will be of benefit to patients.

• 出版日期2006-5