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Biophysics and Mechanisms of Spinal Cord Stimulation for Chronic Pain

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Handbook of Neuroengineering

Abstract

Spinal cord stimulation (SCS) is a well-established treatment for chronic pain. Despite substantial research effort and significant technical advances, clinical success rates have remained stagnant for half a century. Only through increased understanding of the neural mechanisms that drive SCS efficacy will the field improve outcomes for the large patient population suffering from chronic pain. This work seeks to summarize current knowledge and research directions related to the biophysics and mechanisms behind modern SCS therapy.

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Abbreviations

ACC:

Anterior cingulate cortex

BDNF:

Brain-derived neurotrophic factor

CFA:

Complete Freud’s adjuvant

CRPS:

Complex regional pain syndrome

CSF:

Cerebrospinal fluid

DC:

Dorsal columns

DCN:

Dorsal column nuclei

DDH:

Deep dorsal horn

DH:

Dorsal horn

DR:

Dorsal roots

DRG:

Dorsal root ganglion

DRN:

Dorsal raphe nucleus

ECAP:

Evoked compound action potential

EEG:

Electroencephalogram

EPSC:

Excitatory postsynaptic current

FBSS:

Failed back surgery syndrome

FEM:

Finite element method

fMRI:

Functional magnetic resonance imaging

GABA:

Gamma-aminobutyric acid

IPSC:

Inhibitory postsynaptic current

KHF:

Kilohertz frequency

LC:

Locus coeruleus

LPB:

Lateral parabrachial nucleus

mIPSC:

Miniature inhibitory postsynaptic current

MT:

Motor threshold

NS:

Nociceptive specific

PAG:

Periaqueductal gray matter

PKCγ:

γ variant of protein kinase C

RCT:

Randomized controlled trial

RVLM:

Rostral ventrolateral medial nucleus

SCS:

Spinal cord stimulation

SDH:

Superficial dorsal horn

VPL:

Ventral posterolateral nucleus of the thalamus

WDR:

Wide dynamic range

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  1. Department of Biomedical Engineering, Duke University, Durham, NC, USA

    Nathan D. Titus, John E. Gilbert & Warren M. Grill

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  1. Nathan D. Titus
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  2. John E. Gilbert
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    Nitish V. Thakor

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  1. National University of Singapore, Singapore, Singapore

    Nuan Chen Ph.D

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Titus, N.D., Gilbert, J.E., Grill, W.M. (2021). Biophysics and Mechanisms of Spinal Cord Stimulation for Chronic Pain. In: Thakor, N.V. (eds) Handbook of Neuroengineering. Springer, Singapore. https://doi.org/10.1007/978-981-15-2848-4_99-2

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