Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action.
Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action.
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DOI：
10.1186/s42234-019-0023-1
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发表时间：
2019-06-28
影响因子：
--
通讯作者：
Lerman, Imanuel
中科院分区：
文献类型：
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作者：
Caylor, Jacob;Reddy, Rajiv;Lerman, Imanuel
脊髓电刺激（SCS）在生物电子医学领域已经建立，为患有顽固性慢性疼痛疾病的患者提供了一种植入式非药物治疗。慢性疼痛在病理生理学和由此产生的表型方面是一种广泛异质的综合征。尽管我们对SCS介导的抗伤害感受的理解有所进展，但仍然存在有限的证据来澄清当模式电脉冲施加到硬膜外腔时招募的途径。新型SCS方法的快速临床实施，包括爆发、高频和背根神经节SCS，为临床医生提供了治疗难治性慢性疼痛的多种选择。虽然存在令人信服的安全性和有效性证据支持这些新的范式，但我们对其作用机制（MOA）的理解远远落后于临床数据。在这篇综述中，我们重建了现有的基础科学和临床文献，为感觉异常脊髓刺激（P-SCS）和无感觉异常脊髓刺激（PF-SCS）的机制提供支持。虽然P-SCS自成立以来一直受到严格审查，但PF-SCS范例最近在有限的临床前研究支持下获得了临床批准。因此，在其临床疗效和MOA之间存在广泛的知识差距。为了缩小这一差距，P-SCS和PF-SCS的许多丰富的研究途径正在进行中，这将进一步为SCS的范式优化、连续治疗和新适应症打开大门。随着我们对这些机制的理解的发展，临床医生将有可能使用SCS选择性地靶向慢性疼痛中的特定病理生理过程来改善患者护理。
Well-established in the field of bioelectronic medicine, Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. Despite advances in our understanding of SCS-mediated antinociception, there still exists limited evidence clarifying the pathways recruited when patterned electric pulses are applied to the epidural space. The rapid clinical implementation of novel SCS methods including burst, high frequency and dorsal root ganglion SCS has provided the clinician with multiple options to treat refractory chronic pain. While compelling evidence for safety and efficacy exists in support of these novel paradigms, our understanding of their mechanisms of action (MOA) dramatically lags behind clinical data. In this review, we reconstruct the available basic science and clinical literature that offers support for mechanisms of both paresthesia spinal cord stimulation (P-SCS) and paresthesia-free spinal cord stimulation (PF-SCS). While P-SCS has been heavily examined since its inception, PF-SCS paradigms have recently been clinically approved with the support of limited preclinical research. Thus, wide knowledge gaps exist between their clinical efficacy and MOA. To close this gap, many rich investigative avenues for both P-SCS and PF-SCS are underway, which will further open the door for paradigm optimization, adjunctive therapies and new indications for SCS. As our understanding of these mechanisms evolves, clinicians will be empowered with the possibility of improving patient care using SCS to selectively target specific pathophysiological processes in chronic pain.