Newly Published
Review Article  |   July 2018
Supraspinal Mechanisms of Spinal Cord Stimulation for Modulation of Pain: Five Decades of Research and Prospects for the Future
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine (E.S., D.P.M., S.N.R., Y.G.), and the Department of Neurological Surgery (Y.G.), School of Medicine, Johns Hopkins University, Baltimore, Maryland; and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (B.L.).
  • Submitted for publication February 13, 2018. Accepted for publication June 8, 2018.
    Submitted for publication February 13, 2018. Accepted for publication June 8, 2018.×
  • Research Support: This study was supported by the National Institutes of Health (Bethesda, Maryland) grant Nos. NS070814 and NS099879 (to Dr. Guan), and NS026363 (to Dr. Raja); by a grant from Neurosurgery Pain Research Institute at Johns Hopkins University (Baltimore, Maryland; to Dr. Guan); and by a Stimulating and Advancing Anesthesiology and Critical Care Medicine Research seed grant (to Dr. Sivanesan) from the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University.
    Research Support: This study was supported by the National Institutes of Health (Bethesda, Maryland) grant Nos. NS070814 and NS099879 (to Dr. Guan), and NS026363 (to Dr. Raja); by a grant from Neurosurgery Pain Research Institute at Johns Hopkins University (Baltimore, Maryland; to Dr. Guan); and by a Stimulating and Advancing Anesthesiology and Critical Care Medicine Research seed grant (to Dr. Sivanesan) from the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins University.×
  • Competing Interests: Drs. Guan and Raja received research grant support from Medtronic, Inc. (Minneapolis, Minnesota). Dr. Linderoth is a consultant for Medtronic, Inc., St. Jude Medical (Austin, Texas), Boston Scientific (Marlborough, Massachusetts), and Elekta AB (Sweden). The other authors declare no competing interests.
    Competing Interests: Drs. Guan and Raja received research grant support from Medtronic, Inc. (Minneapolis, Minnesota). Dr. Linderoth is a consultant for Medtronic, Inc., St. Jude Medical (Austin, Texas), Boston Scientific (Marlborough, Massachusetts), and Elekta AB (Sweden). The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Guan: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205. yguan1@jhmi.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Central and Peripheral Nervous Systems / Pain Medicine
Review Article   |   July 2018
Supraspinal Mechanisms of Spinal Cord Stimulation for Modulation of Pain: Five Decades of Research and Prospects for the Future
Anesthesiology Newly Published on July 17, 2018. doi:10.1097/ALN.0000000000002353
Anesthesiology Newly Published on July 17, 2018. doi:10.1097/ALN.0000000000002353
Abstract

The field of spinal cord stimulation is expanding rapidly, with new waveform paradigms asserting supraspinal sites of action. The scope of treatment applications is also broadening from chronic pain to include cerebral ischemia, dystonia, tremor, multiple sclerosis, Parkinson disease, neuropsychiatric disorders, memory, addiction, cognitive function, and other neurologic diseases. The role of neurostimulation as an alternative strategy to opioids for chronic pain treatment is under robust discussion in both scientific and public forums. An understanding of the supraspinal mechanisms underlying the beneficial effects of spinal cord stimulation will aid in the appropriate application and development of optimal stimulation strategies for modulating pain signaling pathways. In this review, the authors focus on clinical and preclinical studies that indicate the role of supraspinal mechanisms in spinal cord stimulation–induced pain inhibition, and explore directions for future investigations.