Neuropathic extremity pain and spinal cord stimulation

Neuropathic pain of the extremities can be well treated with neurostimulation techniques. Over the past decade, spinal cord stimulation (SCS) has become more elegant and sophisticated, especially as technological improvements have enabled newer techniques of neurostimulation and more precise targeting of electrically excitable neuronal structures within the spinal canal. These structures include the dorsal columns, the dorsal root entry zone (DREZ), and spinal nerve roots (traversing and/or exiting nerve roots). It is thus more appropriate now to think in terms of intraspinal neurostimulation (INS) rather than SCS, per se. The balanced application of neurostimulation techniques at more than one intraspinal neuronal structure can significantly augment the therapeutic efficacy of INS. A type of Dual Modality stimulation technique can be particularly efficacious, as seen with combined nerve root stimulation and dorsal column stimulation (DCS). It is believed that this improved therapeutic effect may stem from the application of neurostimulatory pulses to influence pain pathways other than the dorsal columns (e.g., the lateral spinothalamic tract). In this way, neurostimulation influences a greater number of neuronal systems within the central nervous system (CNS) to effect both stimulatory and inhibitory modulation of the pain signals. New technologies have enabled implanters the opportunity to explore new horizons of neurostimulation therapy for the treatment of chronic neuropathic extremity pain.