ABSTRACT
Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS.
In 1967, Shealy1first introduced dorsal column stimulator for patients suffering from terminal cancer pain based on the gate control theory of pain proposed by Melzack and Wall.2 In the first decade after its introduction, the success of follow-up rate was poor, and the spinal cord stimulation (SCS) soon fell into disrepute due to poor patient selection and technical difficulties. Only in the last decade, the outcome of SCS has improved significantly and became widely accepted therapy for chronic neuropathic pain. While not all patients are suitable for SCS therapy, careful patient selection and evaluation by a multidisciplinary pain management team can improve the selection of appropriate patients.3,4 The search for objective criteria to predict optimal outcome for implantable systems should include a comprehensive psychosocial evaluation to ensure all patients give his or her consent and are mentally sound or received appropriate medication for their mental state
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