A spinal cord stimulator refers to a device used in the exertion of pulses of electrical signals to the spinal cord with an aim of controlling chronic pain. Further applications are also in motor complications and disorders. Spinal spasticity control in the lumbar spinal cord is the most common condition targeted by this process; others include the augmentation of stepping and standing capabilities. In its simplest form, the spinal cord stimulation will include electrodes in the epidural space, electric pulse generators in the lower abdominal region, wires connecting the generator and the electrodes, and the remote control that operates the generator. Spinal cord stimulation has been found to have analgesic properties and is also used in the management of complex regional pain syndrome, pain caused by ischemia and failed back surgery syndrome.
Neurostimulation will deliver low voltages to the targeted spinal cord area to block pain sensations. The Gate control theory of pain by Patrick Wall and Ronald Melzack explains that the neurostimulation will activate the body’s pain inhibition system. According to the proposition of this theory, there exists a gate in the spinal cord which has a responsibility of controlling the flow of pain signals sent to the brain from different parts of the body.
This theory also suggests that the body has the ability to inhibit the pain signals or close this gate when specific non-noxious nerves fibers are activated in the spinal cord (in the dorsal horn). The neurostimulation system in the epidural space will stimulate the pain inhibiting nerve fibers and this will mask the pain and the tingling sensation. This procedure is recommended for a number of pain conditions.
There is a criterion used in the selection of patients who are possible candidates of neurostimulation implants. The patient needs to have a diagnosis emenable to this procedure, has failed conservative therapy and other methods of treatment and significant psychological problems have been ruled out of the list of causes of problems. After the psychiatric evaluation, a 5-7 day situation period follows to demonstrate the effectiveness of the therapy. This part of the process is important because the procedure uses expensive equipment and because of its invasive nature.
This procedure is highly useful when other forms of therapy have failed in the treatment. It has been found to reduce pain as well as medication side effects. Spinal cord stimulation has been found to be effective in between 50 to 70% of the cases. Since it is a procedure that involves invasion, it has some complications such as bleeding, dural puncture and there are risks of equipment failure and disconnection which might lead to complications and problems.
The future of spinal cord stimulation is bright as there are experiments involving the Parkinson’s disease patients. In future, there might be combination of spinal cord stimulation and drug delivery system with an aim of producing synergestic effects which will minimize complications in the procedure as well as side effects but this will depend on the robust research being carried out in different fields.