medicine

Stimulation Techniques

A practical approach has been the use of transcutaneous electric nerve stimulation which is a noninvasive, nonde structive, simple, safe, and inexpensive technique. Davis and Lentini used this approach to treat pain complaints in SCI patients with only modest success. Dorsal column stimillation abolishes the nonspecific responses evoked by peripheral noxious stimuli in the polysynaptic systems of the spinal cord and brainstern. Therefore, it was suggested that dorsal column activation might reduce suffering not only in pain of peripheral origin but also in central pain resulting from spinal cord damage. Therefore, it was suggested that dorsal stimulation might reduce suffering. Not only in pain of peripheral origin but also in central pain resulting from spinal cord damage. Good relief of hyperpathia and dysesthesia associated with SCI, can be achieved   with spinal cord stimulation, but not in cases where there has been thalamic, midbrain, or bulbar damage.
The effects of implantable epidural stimulators was evaluated by Richardson et al for the treatment of intractable pain in paraplegics and  found  no significant long-term effects. Recently, both motor cortex and parietal  cortex stimulation was shown to control central pain temporarily. Meyerson et al reported no pain relief in patients with central pain secondary  to cerebrovascular disease.
Hosobuchi, Tasker, and Peyron et al reported successful pain relief with motor cortex stimulation. Motor cortex stimulation seems superior to thalamic stimulation. Deep brain stimulation is invasive but relatively nondestructive. The regions most commonly stimulated include the ventrobasal thalamus (ventroposterior lateral and medial nuclei) and the periventricular and periaqueductal gray and adjacent nuclei.