ABSTRACT
The gate control theory was originally thought to be the major mechanism of pain relief afforded by spinal cord dorsal column stimulation. Spinal stimulation has been in existence for 40 years, the lack of suitable controls has hampered the performance of randomized trials. Spinal stimulation may produce a conduction blockade of ascending tract input. Spinal stimulation has enjoyed great popularity, particularly in Europe, but some resistance as well. Nociceptive pain has long been regarded as difficult to treat with spinal stimulation, but visceral pain may involve several mechanisms, including inflammatory pain, mixed autonomic neuropathic pain, ischemia, and other causes. Spinal stimulation for the multiple operated back and radicular pain has been buoyed by a recent key randomized trial comparing stimulation to reoperation. Spinal stimulation for intractable angina pectoris is best supported by published trials. Spinal stimulation requires depolarization of a target neuron which is done by activating a negatively charged electrode.
