FWD:RSD World News-Spinal Cord/Nerve Root/Peripheral Nerve Stimulation

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From: byrd45 (Original Message) Sent: 8/6/2006 9:26 PM
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22nd Annual Meeting of the American Academy of Pain Medicine


Spinal Cord/Nerve Root/Peripheral Nerve Stimulation
Electrical neuromodulation (spinal cord stimulation nerve root stimulation and peripheral nerve stimulation) was highlighted in an all-day symposium on complex regional pain syndrome that was a coordinated effort of the North American Neuromodulation Society and the American Academy of Pain Medicine. Robert Foreman, PhD, and Bengt Linderoth, MD, PhD,[1] opened the sessions with an overview of the mechanisms of electrical neuromodulation from the animal models emphasizing the modulation of the GABAergic pathways and wide dynamic range neurons, diminution of excitatory neurotransmitters, and rostral modulation of pathways in the ventrolateral thalamus and spinal cord/brainstem circuitry. Although electrical neuromodulation modalities have been used clinically for more than 25 years, it has only been over the past decade that a clearer understanding of the mechanisms of action has become evident. Clearly, electrical neuromodulation modalities are far superior to medication and physical/psychological therapies in the treatment of neuropathic pain when one looks at the data on functional outcome and pain diminution for syndromes such as complex regional pain syndrome and neuropathic radiculopathies.[2,3] Applications are expanding for electrical neuromodulation because technologic advances have become possible due to the theoretical work in the areas of current steering (empiric work of Jay Law, MD, and later mathematical modeling by Jan Holsheimer, PhD)[4-8]; this has led to the development of multiple independent constant current architecture, a feature that permits more selective capture of nerves.[9-11]

Expansions into the clinical areas of metabolic neuropathies (ie, diabetic neuropathy), chemotherapy-induced neuropathies, facial nerve injuries, migraine headache (via the trigeminal pathway through greater occipital nerve stimulation), and sacral nerve stimulation for complex regional pain syndrome of the bladder (ie, interstitial cystitis) were also discussed in the symposia.[12