Millennium Pain Center - National Spine and Pain Centers, 2406 E Empire, Bloomington, IL, 61704, USA.
Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA.
Curr Pain Headache Rep. 2020 Sep 30;24(11):70. doi: 10.1007/s11916-020-00907-2.
The purpose of the present systematic review is to provide a current understanding of the mechanism of action and the evidence available to support clinical decision-making. The focus is to summarize randomized controlled trials (RCTs) and nonrandomized or observational studies of spinal cord stimulation in chronic pain to understand clinical effectiveness and the mechanism of action.
Several recent studies have demonstrated the benefit of spinal cord stimulation in managing chronic pain. Until recently, the mechanism of action was founded on a central paradigm derived from gate control theory, which is the need to stimulate the dorsal column of the spinal cord to generate paresthesia. The recent development of new therapies that do not rely on paresthesia has left the field without a clear mechanism of action that could serve as a strong foundation to further improve clinical outcomes. Consequently, multiple theories have emerged to explain how electrical pulse applied to the spinal cord could alleviate pain, including activation of specific supraspinal pathways, and segmental modulation of the neurological interaction. Recent systematic reviews also have shown the clinical effectiveness of spinal cord stimulation in managing chronic spinal pain, phantom limb pain, complex regional pain syndrome, and other chronic painful conditions. Spinal cord stimulation for the treatment of chronic pain is rapidly evolving with technology at its forefront. This comprehensive focused review evaluated 11 RCTs and 7 nonrandomized/observational studies which provided levels of evidence ranging from I to II.
本系统综述的目的是提供对作用机制的现有理解，并提供支持临床决策的证据。重点总结脊髓刺激治疗慢性疼痛的随机对照试验（RCT）和非随机或观察性研究，以了解临床疗效和作用机制。
最近的几项研究表明脊髓刺激在治疗慢性疼痛方面具有益处。直到最近，作用机制还是基于源自门控理论的中枢范式，即需要刺激脊髓背柱以产生感觉异常。最近开发的不依赖感觉异常的新疗法使该领域缺乏明确的作用机制，无法为进一步改善临床结果提供坚实的基础。因此，出现了多种理论来解释施加在脊髓上的电脉冲如何缓解疼痛，包括特定的皮质上通路的激活，以及神经相互作用的节段性调节。最近的系统综述还表明，脊髓刺激治疗慢性脊髓疼痛、幻肢痛、复杂性区域疼痛综合征和其他慢性疼痛疾病具有临床疗效。脊髓刺激治疗慢性疼痛的技术迅速发展，处于前沿地位。这项全面的重点综述评估了 11 项 RCT 和 7 项非随机/观察性研究，提供了从 I 级到 II 级的证据水平。
