Implantable devices for pain control: spinal cord stimulation and intrathecal therapies

Untreated chronic pain is costly to society and to the individual suffering from it. The treatment of chronic pain, a multidimensional disease, should rely on the expertise of varying health care providers and should focus not only on the neurobiological mechanisms of the process but also on the psy...

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Bibliographic Details
Published in:Best practice & research. Clinical anaesthesiology 2002-12, Vol.16 (4), p.619-649
Main Author: Krames, Elliot
Format: Article
Language:English
Subjects:
Adrenergic alpha-Agonists - administration & dosage
Analgesics, Opioid - administration & dosage
Anesthetics, Local - administration & dosage
Calcium Channel Blockers - administration & dosage
Chronic Disease
Drug Combinations
Electric Stimulation Therapy - instrumentation
Electric Stimulation Therapy - methods
Electrodes, Implanted
Humans
implantable devices
Infusion Pumps, Implantable
Injections, Spinal
intrathecal therapies
Narcotics - administration & dosage
Pain, Intractable - physiopathology
Pain, Intractable - therapy
Spinal Cord - physiopathology
Spinal Cord - surgery
spinal cord stimulation
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Summary:Untreated chronic pain is costly to society and to the individual suffering from it. The treatment of chronic pain, a multidimensional disease, should rely on the expertise of varying health care providers and should focus not only on the neurobiological mechanisms of the process but also on the psychosocial aspects of the disease. Implantable devices are costly and invasive, and such efficacious therapies should be used only when more conservative and less costly therapies have failed to provide relief of pain and suffering. Spinal cord stimulation provides neuromodulation of neuropathic, but not nociceptive, pain signals and when used for appropriate indications in the right individuals provides approximately 60–80% long-term pain relief in 60–80% of patients trialled for efficacy. Intrathecal therapies with opioids such as morphine, fentanyl, sufentanil or meperidine – or non-opioids such as clonidine or bupivacaine – provide analgesia in patients with nociceptive or neuropathic pain syndromes. Baclofen, intrathecally, provides profound relief of muscle spasticity due to multiple sclerosis, spinal cord injuries, brain injuries or cerebral palsy.
ISSN:1521-6896
1532-169X
DOI:10.1053/bean.2002.0263