Electrial Stimulation and the Relief of Pain

Edited by B. A. Simpson
Hardbound
ISBN: 0444512586, 300 pages
Publication date: 2003
ELSEVIER

This book covers the field of neurostimulation, and as a clinician familiar with DCS for low-back-pain with mixed-pain-types, I find it of great importance to learn about all cases in which electrical stimulation can relieve pain.

The book consists of 16 chapters, and the authors are all experts in their respective fields; there are more than 1200 references, so the reader can get most of the relevant information of electrical stimulation that is available!

Of interest is that electrical stimulation has been used for thousands of years, and as stated in chapter 2 "The Greeks called the electric ray narke or 'numbness-producing', from which the word narcosis was coined".

In 1965 Melzack & Wall postulated central inhibition of pain by non-painful stimuli, the GATE THEORY OF PAIN. In the following few years the neurosurgeon Norman Shealy made some interesting experiments, "closing the gate" by stimulating the dorsal columns. Shortly afterwards, the methods of TENS was introduced, too, and the technology was developed, so that the Cordis IPG model 900X was approved by the FDA for pain relief in 1981.

Today electrical stimulation is applied not only on the spinal cord and peripheral nerves, but also to the thalamus, peri-aqueductal and peri-ventricular gray matter, and as stated by Umberto Rossi in chapter 2: "Therapeutic electrical neural stimulation is an established, systematic, interdisciplinary field of science, with a continuating search for 'optimization' under the auspices of the International Neuromadolation Society."

The range of conditions in which electrical stimulation is applicable includes failed back surgery, ischaemic peripheral vascular disease, atypical trigeminal neuralgis, refractory angina pectoris, reflex sympathetic dystrophy, interstitial cystitis, occipital neuralgis and ilioinguinal neuralgia.

After a chapter decribing the principles of neurostimulation (for a clinician a complex area), the rest of the chapters describe electrical stimulation for the conditions mentioned above. I found it of special interest to read about sacral nerve root stimulation for interstitial cystitis, as this disease is now known to be a debilitating neuropathic pain syndrome, likened to "reflex sympathetic dystrophy of the bladder".

In this book the old term "reflex sympathetic dystrophy" is still used, but in chapter 8, describing spinal cord stimulation for this syndrome, the new term Complex Regional Pain Syndrome is correctly used.

Spinal cord stimulation is expanding, and it is estimated that 15,000 systems were implanted each year – of these 5,000 in Europe. The longterm effect has been found to be 80% for angina pectoris, 60-70% for pronounced peripheral arterial circulatory insufficiency and 50% for chronic neurogenic pain.

I can recommend this book for anyone who is working with electrical stimulation or is interested in the field.

Anders Schou Olesen
Chief Consultant
Multidisciplinary Pain Center
Nybrogade 16
DK-9000 Aalborg
Denmark
Email: an.5.afdeling@nja.dk