Effectiveness of spinal cord stimulation in the management of chronic pain: Analysis of technical drawbacks and solutions
Effectiveness of spinal cord stimulation in the management of chronic pain: Analysis of technical drawbacks and solutions
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DOI：
10.1097/0006123-199705000-00023
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发表时间：
1997-05-01
期刊：
影响因子：
4.8
通讯作者：
Holsheimer, J
中科院分区：
文献类型：
--
作者：
Holsheimer, J
目的：目前可用的脊髓刺激（SCS）系统用于管理慢性顽固性疼痛，特别是反射性交感神经营养不良中的广泛疼痛模式的主要缺点是通常有限的感觉异常覆盖。本研究的目的是分析这个问题的起源，并提供solutions.METHODS：结果从理论研究，其中一个计算机模型被用来模拟脊髓刺激对脊髓神经纤维的影响，被用来分析哪些因素可能会限制感觉异常的覆盖范围。结果：当使用普通SCS电极时，感知阈值和运动/不适阈值通常与背根刺激相关，由于这两个阈值的比例很小（类似于1：1.4），因此背柱纤维的刺激和感觉异常的覆盖范围受到这种小范围刺激的限制。当硬膜外电极和脊髓之间的距离较大时（胸中部），背柱刺激的阈值超过不适阈值，仅导致节段性感觉异常。当使用最佳尺寸的喙尾双/三极或横向三极（“保护阴极”）时，可以改善背柱刺激和感觉异常覆盖范围。当应用后者与双通道脉冲发生器提供同步脉冲相结合时，可以简单地改变感觉异常，以最佳地覆盖疼痛区域。结论：使用电极时，可以改善感觉异常的覆盖范围和疼痛管理。
OBJECTIVE: A major drawback of currently available spinal cord stimulation (SCS) systems for the management of chronic intractable pain, especially of widespread pain patterns as in reflex sympathetic dystrophy, is the generally limited paresthesia coverage. The aim of this study is to analyze the origin of this problem and to provide solutions.METHODS: Results from theoretical studies, in which a computer model was used to mimic the effects of SCS on spinal nerve fibers, were used to analyze which factors may limit paresthesia coverage. Model predictions were verified by empirical data from clinical literature.RESULTS: When using common SCS electrodes, both perception threshold and motor/discomfort threshold are generally related to dorsal root stimulation, Because these thresholds have a small ratio (similar to 1:1.4), stimulation of dorsal column fibers and paresthesia coverage is limited by this small range of stimulation. When the distance between the epidural electrode and spinal cord is large (midthoracically), the threshold for dorsal column stimulation exceeds discomfort threshold, resulting only in segmental paresthesia. The range of dorsal column stimulation and paresthesia coverage can be improved when using either an optimally dimensioned rostrocaudal bi-/tripole or a transverse tripole (''guarded cathode''). When applying the latter in combination with a dual channel pulse generator providing simultaneous pulses, paresthesias can simply be changed to optimally cover the painful area.CONCLUSION: Paresthesia coverage and pain management by SCS can be improved when using electrodes as proposed.