This groundbreaking work into the field of bioelectronic medicine ultimately opened the door for SCS and the rise of targeted neuromodulation.

The gate-control theory of pain proposed by Melzack and Wall in 1965 spurred development of conventional Spinal Cord Stimulation (SCS), first surgically implanted in 1967 by Shealy, who noted that paresthesia elicited by electrical stimulation of the dorsal columns (DC) inhibited deep pain due to metastatic lung cancer (Melzack & Wall, 1965 Shealy et al., 1967). While the advent of multi-modal and multidisciplinary treatment approaches has improved strategies for chronic pain management, the push for opiate-free therapies has inspired development of novel approaches to both nociceptive and neuropathic pain syndromes. 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.Ĭhronic Pain is a heterogenous, complex syndrome with significant burden for both the patient and the healthcare system. 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. Thus, wide knowledge gaps exist between their clinical efficacy and MOA. 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. 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 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. 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. 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. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. 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.

Placement of a dorsal column stimulator