ABSTRACT
Transcutaneous stimulation of the nervous system using electricity applied through the skin has been used empirically for pain control since dependable sources of electricity have been available. Benjamin Franklin experimented with electrical stimulation for the treatment of trigeminal neuralgia. During the nineteenth century, an enormous array of portable and office electrical devices were marketed throughout the world for treatment of disease and relief of pain. The claims for many were absurd, but one consistent theme was relief of pain. One of the largest and most expensive of these devices provided electricity for fulguration of the hemorrhoids at one end of the spectrum and application to the skin for pain control on the other (27). The modern era of neuroaugmentation began when Wall and Sweet observed control of pain with transcutaneous electrical stimulation of the trigeminal system (41, 43). This was the first practical application of the justly famous gate-control theory of pain perception and modulation (33). Before publication of the gate-control theory by Melzack and Wall, neurosurgical involvement in pain had been primarily destructive. Shealy was the first to apply the basic concepts of the theory and the human observations of Sweet and Wall to control pain by modification of nervous system function, rather than destruction of pain pathways. The development of spinal cord stimulation first proposed by Shealy is described in greater detail in Chapter 7. After his first scientific publication (1967) and the oral presentation at the annual meeting of the American Association of Neurological Surgeons that followed, an interested group of neurosurgeons joined together to form a study group to investigate the feasibility of spinal cord stimulation for control of chronic pain.
