Innovations in spinal cord stimulation for pain
Innovations in spinal cord stimulation for pain
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DOI：
10.1016/j.cobme.2018.10.005
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发表时间：
2018-12-01
影响因子：
3.9
通讯作者：
Patil, Parag G.
中科院分区：
文献类型：
--
作者：
Lempka, Scott F.;Patil, Parag G.
脊髓刺激（SCS）是一种用于治疗医学难治性慢性疼痛的神经调节疗法。在SCS中，植入的脉冲发生器产生电信号，这些电信号通过位于脊髓区域的电极阵列传递。SCS的目的是通过脊柱和棘上机制调节神经信号以减轻疼痛。虽然已有几十年的历史，但SCS仍然只有有限的临床成功，有限的生活质量改善和有限的长期疗效。为了改善SCS的结果，最近引入了引线设计、刺激器功能和波形范例方面的进展。虽然这是神经调节领域的一个激动人心的时刻，但经验上的SCS进展已经超过了对SCS作用机制的科学理解。我们仍然不知道为什么SCS对一些病人有效而对另一些病人无效。我们也缺乏信息丰富的疼痛和疼痛缓解的生物标志物，通过这些生物标志物来优化SCS编程。为了优化SCS的系统设计和临床实施，解决这些科学和机械知识差距至关重要。
Spinal cord stimulation (SCS) is a neuromodulation therapy used to treat medically refractory chronic pain. In SCS, an implanted pulse generator produces electrical signals that are conveyed through electrode arrays located in the region of the spinal cord. The goal of SCS is to modulate neural signaling through spinal and supraspinal mechanisms to reduce pain. Although available for decades, SCS still enjoys only limited clinical success, limited quality-of-life improvement, and limited long-term efficacy. To improve SCS outcomes, advances in lead design, stimulator features, and waveform paradigms have been recently introduced. While it is an exciting time for the neuromodulation field, empirical SCS advances have surpassed scientific understanding of SCS mechanisms of action. We still do not know why SCS works in some patients but not in others. We also lack information-rich biomarkers of pain and pain relief through which to optimize SCS programming. To optimize both system designs and clinical implementations of SCS, it is critical that we address these scientific and mechanistic knowledge gaps.