Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

Andrei D. Sdrulla, Yun Guan, Srinivasa N. Raja

Research output: Contribution to journalReview articlepeer-review

58 Scopus citations


Spinal cord stimulation (SCS) is a minimally invasive therapy used for the treatment of chronic neuropathic pain. SCS is a safe and effective alternative to medications such as opioids, and multiple randomized controlled studies have demonstrated efficacy for difficult-to-treat neuropathic conditions such as failed back surgery syndrome. Conventional SCS is believed mediate pain relief via activation of dorsal column Aβ fibers, resulting in variable effects on sensory and pain thresholds, and measurable alterations in higher order cortical processing. Although potentiation of inhibition, as suggested by Wall and Melzack's gate control theory, continues to be the leading explanatory model, other segmental and supraspinal mechanisms have been described. Novel, non-standard, stimulation waveforms such as high-frequency and burst have been shown in some studies to be clinically superior to conventional SCS, however their mechanisms of action remain to be determined. Additional studies are needed, both mechanistic and clinical, to better understand optimal stimulation strategies for different neuropathic conditions, improve patient selection and optimize efficacy.

Original languageEnglish (US)
Pages (from-to)1048-1067
Number of pages20
JournalPain Practice
Issue number8
StatePublished - Nov 2018


  • complex regional pain syndromes
  • low back pain
  • pain syndromes
  • postoperative pain
  • regional complex
  • spinal cord stimulation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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