Spinal Cord Stimulation for Visceral Pain: Present Approaches and Future Strategies
| Autor: | Leonardo Almeida Frizon, Yusuke S. Hori, Amy C S Pearson, Logan Helland, Sean J. Nagel, Saul Wilson, Marshall T. Holland, Andre G. Machado, George T. Gillies, Royce W. Woodroffe, Amy Pearlman, Haring J.W. Nauta, Matthew A. Howard |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Spinal cord stimulation Pelvic Pain 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Medicine Humans Intensive care medicine Somatoform Disorders Spinal Cord Stimulation business.industry Pelvic pain Extremity Pain Chronic pain Visceral pain General Medicine Visceral Pain medicine.disease Neuromodulation (medicine) Anesthesiology and Pain Medicine medicine.anatomical_structure Spinal Cord Percutaneous therapy Neurology (clinical) medicine.symptom Chronic Pain business 030217 neurology & neurosurgery Neuroanatomy |
| Zdroj: | Pain medicine (Malden, Mass.). 21(10) |
| ISSN: | 1526-4637 |
| Popis: | IntroductionThe introduction of successful neuromodulation strategies for managing chronic visceral pain lag behind what is now treatment of choice in refractory chronic back and extremity pain for many providers in the United States and Europe. Changes in public policy and monetary support to identify nonopioid treatments for chronic pain have sparked interest in alternative options. In this review, we discuss the scope of spinal cord stimulation (SCS) for visceral pain, its limitations, and the potential role for new intradural devices of the type that we are developing in our laboratories, which may be able to overcome existing challenges.MethodsA review of the available literature relevant to this topic was performed, with particular focus on the pertinent neuroanatomy and uses of spinal cord stimulation systems in the treatment of malignant and nonmalignant gastrointestinal, genitourinary, and chronic pelvic pain.ResultsTo date, there have been multiple off-label reports testing SCS for refractory gastrointestinal and genitourinary conditions. Though some findings have been favorable for these organs and systems, there is insufficient evidence to make this practice routine. The unique configuration and layout of the pelvic pain pathways may not be ideally treated using traditional SCS implantation techniques, and intradural stimulation may be a viable alternative.ConclusionsDespite the prevalence of visceral pain, the application of neuromodulation therapies, a standard approach for other painful conditions, has received far too little attention, despite promising outcomes from uncontrolled trials. Detailed descriptions of visceral pain pathways may offer several clues that could be used to implement devices tailored to this unique anatomy. |
| Databáze: | OpenAIRE |
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