Spinal cord stimulation in chronic pain management.
As a general rule, even though it is always difficult to predict the efficacy of a method ina single patient, we consider SCS in every non-malignant chronic pain patient when other conservative treatments have failed. After three decades of clinical experience with SCS, we have learned a lot about its efficacy indifferent pain conditions and have made great technical progress with the materials and surgical procedures. Acceptance of the technique was slow at the beginning; however, we must be aware of the problems related to the application of a therapy that cannot be shamed, and thus the necessity of performing studies that include large numbers of patients. This is even more complicated when dealing with pain patients because of the well-known multifactoriality of pain. Nowadays, every algorithm for the treatment of different pain conditions includes SCS; consequently, every pain center should be able to offer this therapy in its treatment program. This article discusses what has been learned so far with regard to SCS, but there is a lot more to learn about this technique as well as about other types of neuromodulation procedures. As mentioned in the introduction of this article and discussed in the section on the effects of SCS, particularly in clinical applications like peripheral vascular disease and angina, the results of the interaction with the function of the nervous system can be observed in other systems in the body affecting pathologic conditions that are of interest to different specialists. Only the strict cooperation of different medical disciplines can provide substantial help in acquiring knowledge about the mechanisms put into play by SCS and the possible extension of its clinical applications. The complexity of the procedures of neuromodulation and the theoretic background needed for safe and proficient clinical use and for progress raise the issue for medical schools of offering courses in this new discipline.
Meglio
Mario
M
Functional and Stereotactic Neurosurgery, Istituto Neurochirurgia, Policlinico A. Gemelli, Rome, Italy. mmeglio@rm.unicatt.it
D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D013116:Spinal Cord / Q000503:physiopathology*; D016896:Treatment Outcome