In order to expand these stimulation options further, a multi-array of electrodes is situated at the ends of the leads usually this comprises of 4, 8 or 16 electrode contacts. If more electrodes are available, the number of pattern combinations that can be tested is increased. The electrode stimulation pattern is controlled externally and each pattern will induce a slightly different sensation, some of which will provide more pain relief than others. More electrodes placed in the spinal cord provides more paraesthesia options, because not all electrodes are stimulated at all times. A more widespread, higher degree of pain requires more electrodes to be placed in the epidural space. The number of electrodes used is determined by the level and complexity of the pain experienced. The electrodes are implanted in the epidural space at the level of the spinal cord, which innervates the area where the pain is experienced. SCS evokes paraesthesia by transmitting electric pulses through connecting leads to the electrodes. The power is supplied in pulses that are adjusted to suit the individual’s paraesthetic needs.įor a general overview on SCS, including more information on the mechanisms behind paraesthesia, and the indications, costs, advantages, risks and contraindications of SCS, see Spinal Cord Stimulation. The leads transmit the electric current that stimulates the pain inhibition pathways this is powered by an external or internal source, known as the neuromodulator. The electrodes are connected to wires or leads threaded through the epidural space. Therefore if the pain is experienced in the chest area, the electrodes will be placed at the level of the spinal cord where the nerves emerge to innervate the chest. For example, the nerves that supply the fingers exit the central nervous system at one level of the spinal cord, and the nerves that supply the toes exit at a different level. Different levels of the spinal cord innervate different areas of the body. SCS involves implanting electrodes into the epidural space near the source of pain. SCS does not eliminate pain but creates a numbness called paraesthesia in the area. It is for this reason that SCS is a very exciting area of development and is becoming widely accepted for use in many areas of neuropathic pain management. Neuropathic pain is caused by abnormal nerve signalling in the nervous system and, as a result, commonly does not respond to most pain relief strategies. Neuropathic pain is one of the most difficult medical conditions to treat it is not the “normal” pain we associate with stubbing a toe or getting a paper cut – this is nocioceptive pain. Spinal cord stimulation ( SCS) is an emerging, minimally invasive procedure used to treat chronic, refractory, neuropathic pain. Overview of spinal cord stimulation (SCS)
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