Mechanisms of spinal cord stimulation for the treatment of pain: Still in the dark after 50 years.
Mechanisms of spinal cord stimulation for the treatment of pain: Still in the dark after 50 years.
复制标题
治疗疼痛的脊髓刺激机制：50年后仍处于黑暗状态。
DOI：
10.1002/ejp.1336
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发表时间：
2019-04
期刊：
影响因子：
--
通讯作者：
Brownstone RM
中科院分区：
文献类型：
--
作者：
Jensen MP;Brownstone RM
尽管脊髓刺激（SCS）在治疗一些局灶性神经性疼痛患者中的价值，但刺激器设计和治疗方案的技术进步并未与临床结果的显着改善相关。这可能是因为对SCS机制的不完全理解阻碍了临床疗效的提高。在这篇简短的综述中，我们(a)回顾了SCS的现象学效应，(b)回顾了关于SCS的脊髓作用部位的文献，(c)提出了一种新的作用机制假设。背柱、背根和背角分别被认为是脊髓内SCS的作用部位。我们认为，支持背柱或背根作为SCS的主要介质的证据是薄弱的，并提出背角是关键的作用部位。此外，我们假设，根据背角胰岛细胞的位置、神经化学和形态学特性，它们可能介导SCS的作用。SCS在脊髓中的确切作用机制尚不清楚。背角胰岛细胞的特性使它们在电刺激的镇痛作用中发挥关键作用。了解SCS的积极作用机制是成功转化为临床红利的必要条件。我们回顾了脊髓刺激对神经性疼痛的可能的脊髓机制，提出直接调节背角神经元是至关重要的。我们认为，需要将机制见解转化为更有利的临床结果。
Despite the value of spinal cord stimulation (SCS) in treating some patients with focal neuropathic pain, technological advances in stimulator design and treatment protocols have not correlated with significant improvements in clinical outcomes. This may be because incomplete understanding of the mechanisms underlying SCS precludes improvement in clinical efficacy. In this brief review, we (a) review phenomenological effects of SCS, (b) review the literature on proposed spinal sites of action of SCS and (c) propose a novel hypothesis of mechanism of action. Dorsal columns, dorsal roots and dorsal horns have each been proposed as spinal sites of action of SCS. We suggest that evidence in favour of the dorsal columns or dorsal roots as the primary mediators of SCS is weak and propose that the dorsal horn is the crucial site of action. Furthermore, we hypothesize that, based on their location, and neurochemical and morphological properties, dorsal horn islet cells may mediate the effects of SCS. The precise spinal mechanisms of action of SCS are still unknown. Dorsal horn islet cells have properties that position them to play a key role in analgesic effects of electrical stimulation. Understanding the mechanisms responsible for positive SCS effects are needed for successful translation into clinical dividends. We review possible spinal mechanisms of action of spinal cord stimulation for neuropathic pain, proposing that direct modulation of dorsal horn neurons is crucial. We suggest that mechanistic insights are needed for translation into more favourable clinical outcomes.
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