3 In 1993, a 7-yr follow-up of 320 consecutive patients who had spinal cord stimulation placement for chronic intractable pain found that 52% still reported at least 50% relief of pain. 2 As we pass the fiftieth anniversary since Norman Shealy implanted the first spinal cord stimulation system in 1967, the clinical effectiveness of spinal cord stimulation has made steady progress, with more significant advancements in the last decade. 1 Growth of this field is moving at a rapid pace with an estimate of the worldwide neuromodulation systems market reaching more than 7 billion U.S. In this review, the authors focus on clinical and preclinical studies that indicate the role of supraspinal mechanisms in spinal cord stimulation–induced pain inhibition, and explore directions for future investigations.Īccording to the American Association of Neurologic Surgeons, approximately 50,000 spinal cord stimulators are implanted per year, worldwide. An understanding of the supraspinal mechanisms underlying the beneficial effects of spinal cord stimulation will aid in the appropriate application and development of optimal stimulation strategies for modulating pain signaling pathways. The role of neurostimulation as an alternative strategy to opioids for chronic pain treatment is under robust discussion in both scientific and public forums. The scope of treatment applications is also broadening from chronic pain to include cerebral ischemia, dystonia, tremor, multiple sclerosis, Parkinson disease, neuropsychiatric disorders, memory, addiction, cognitive function, and other neurologic diseases. The field of spinal cord stimulation is expanding rapidly, with new waveform paradigms asserting supraspinal sites of action.
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