An introduction to the use of spinal cord stimulator therapy for chronic pain states as an adjunct and adjuvant
therapy. Spinal cord stimulators are meant for patients who have failed conservative modalities, medications, and even surgery. It is a modality to restore function and pain relief.
4. CHRONIC PAINCHRONIC PAIN
‣ Neuropathic pain arises as a direct consequence of a lesion orNeuropathic pain arises as a direct consequence of a lesion or
disease affecting the somatosensory system (Loeser anddisease affecting the somatosensory system (Loeser and
Treede,2008).Treede,2008).
‣ It is generally more severe and more likely to be drug-resistantIt is generally more severe and more likely to be drug-resistant
and persistent than nociceptive painand persistent than nociceptive pain
5. The Precision Spectra™ SCS System is used as an aid in theThe Precision Spectra™ SCS System is used as an aid in the
management of:management of:
‣ A spinal cord stimulator is a device used to exert pulsedA spinal cord stimulator is a device used to exert pulsed
electrical signals to the spinal cord to control chronic painelectrical signals to the spinal cord to control chronic pain
‣ Spinal cord stimulation(SCS) is an adjustable, non-destructive,Spinal cord stimulation(SCS) is an adjustable, non-destructive,
neuromodulatory procedure which delivers therapeutic doses ofneuromodulatory procedure which delivers therapeutic doses of
electrical current to the spinal cord for the management ofelectrical current to the spinal cord for the management of
neuropathic painneuropathic pain
Spinal Cord StimulatorSpinal Cord Stimulator
6. GATE THEORY OF PAINGATE THEORY OF PAIN
‣ Melzack and Wall : 1965Melzack and Wall : 1965
‣ This theory proposed that nerves carrying painfulThis theory proposed that nerves carrying painful
peripheral stimuli and nerves carrying touch andperipheral stimuli and nerves carrying touch and
vibratory sensation both terminate in the dorsalvibratory sensation both terminate in the dorsal
horn (the gate) of spinal cord.horn (the gate) of spinal cord.
‣ It was hypothesized that input to the latter could beIt was hypothesized that input to the latter could be
manipulated to “close the gate” to the former.manipulated to “close the gate” to the former.
9. RELEVANT ANATOMYRELEVANT ANATOMY
‣ A basic tenet of SCS is to create an overlapping ofA basic tenet of SCS is to create an overlapping of
paresthesia and pain region.paresthesia and pain region.
‣ In order to do this, correlation of the somatotopy andIn order to do this, correlation of the somatotopy and
the level of the spinal cord is necessary.the level of the spinal cord is necessary.
14. MECHANISM OF ACTIONMECHANISM OF ACTION
‣ BarolatBarolat
‣ 1993: Mapping of Sensory Responses1993: Mapping of Sensory Responses
‣ 1998: Anatomical and Electrical properties of the1998: Anatomical and Electrical properties of the
intraspinal structures and clinical correlationsintraspinal structures and clinical correlations
‣ Chemical Level: studies suggest that SCS triggersChemical Level: studies suggest that SCS triggers
release of Serotonin, Substance P, GABA within therelease of Serotonin, Substance P, GABA within the
dorsal horndorsal horn
‣ Descending InhibitionDescending Inhibition
15. MECHANISM OF ACTIONMECHANISM OF ACTION
‣ Stimulate the neurons of the dorsal horn of the spinal cord to release increasedStimulate the neurons of the dorsal horn of the spinal cord to release increased
amount of acetylcholine and GABA and decreased amounts of aspartate andamount of acetylcholine and GABA and decreased amounts of aspartate and
glutamate in rat modelsglutamate in rat models
‣ Induce neurophysiological change, normalizing neuronal hyperexcitability in theInduce neurophysiological change, normalizing neuronal hyperexcitability in the
dorsal horndorsal horn
‣ Functional alteration at the supraspinal level has been suggested to play anFunctional alteration at the supraspinal level has been suggested to play an
important role in pain reductionimportant role in pain reduction
18. CONCLUSIONCONCLUSION
‣ SCS Technology - constantly improvingSCS Technology - constantly improving
‣ Equipment and SoftwareEquipment and Software
‣ Reliable and SafeReliable and Safe
‣ Goal:Goal:
‣ Reduce PainReduce Pain
‣ Improve FunctionImprove Function
‣ Increasing Amount of UsesIncreasing Amount of Uses
‣ SCS is analgesia on demandSCS is analgesia on demand
