Modulation of spinal pain mechanisms by spinal cord stimulation and the potential role of adjuvant pharmacotherapy.
Experimental studies indicate that the effects of spinal cord stimulation (SCS) on 'hypersymptoms' in neuropathic pain conditions may at least partly be mediated via GABAergic and adenosine-dependent mechanisms. Concomitant intrathecal administration of receptor-active drugs modulating the function of the GABA and adenosine systems may both depress and enhance the effects of SCS. The first few patients with simultaneous intrathecal administration of the GABAB agonist baclofen and/or adenosine together with SCS, when the stimulation alone proved insufficient, are reported.
Meyerson
B A
BA
Department of Neurosurgery, Karolinska Institute/Hospital, Stockholm, Sweden. bengtl@neuro.ks.se
Cui
J G
JG
Yakhnitsa
V
V
Sollevi
A
A
Segerdahl
M
M
Stiller
C O
CO
O'Connor
W T
WT
Linderoth
B
B
D000241:Adenosine / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D001418:Baclofen / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D001522:Behavior, Animal / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004599:Electric Stimulation Therapy; D018756:GABA Antagonists / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000517:prevention & control*; D059408:Pain Management; D017288:Pain Threshold / Q000187:drug effects; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D051381:Rats; D017207:Rats, Sprague-Dawley; D018079:Receptors, GABA / Q000187:drug effects / Q000502:physiology; D018047:Receptors, Purinergic P1 / Q000187:drug effects / Q000502:physiology; D013116:Spinal Cord / Q000187:drug effects / Q000502:physiology*; D014110:Touch / Q000502:physiology; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000494:pharmacology
D018756:GABA Antagonists; D018079:Receptors, GABA; D018047:Receptors, Purinergic P1; C047235:N-(1-methyl-2-phenylethyl)adenosine; D005680:gamma-Aminobutyric Acid; D001418:Baclofen; D000241:Adenosine