Deer TR, Raso LJ. Spinal cord stimulation for refractory angina pectoris and peripheral vascular disease

The Center for Pain Relief, Charleston, West Virginia 25301, USA.
Pain physician (Impact Factor: 3.54). 11/2006; 9(4):347-52.
Source: PubMed


Spinal cord stimulation has been used in clinical practice for more than three decades. The primary use of this therapy has been in spine-related disorders. In recent years, the therapy has been used more extensively in diseases of the vascular system. Increasingly, interest has piqued in using this mode of treatment for refractory angina and ischemic pain secondary to peripheral vascular disease. In this publication, we review the current literature on these two indications and present case examples of both therapies.

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Available from: Louis J Raso, Aug 25, 2014
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    • "(Cameron 2004). Although SCS usually is the last resort after vascular surgery and medications failed to prevent the development of a disease, the success rate is above 60% in the long term (Deer and Raso, 2006). However, mechanisms of SCS-induced vasodilation are still not fully understood. "
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    ABSTRACT: SCS is used to improve peripheral circulation in selected patients with ischemia of the extremities. However the mechanisms are not fully understood. The present study investigated whether blockade of ERK and AKT activation modulated SCS-induced vasodilation. A unipolar ball electrode was placed on the left dorsal column at the lumbar 2-3 spinal segments in rats. Cutaneous blood flows from left and right hind foot pads were recorded with laser Doppler flow perfusion monitors. SCS was applied through a ball electrode at 60% or 90% of MT. U0126, an inhibitor of ERK kinase, or LY294002, an inhibitor of PI3K upstream of AKT, was applied to the lumbar 3-5 spinal segments (n=7, each group). U0126 (100 nM, 5 microM and 250 microM) significantly attenuated SCS-induced vasodilation at 60% (100 nM: P<0.05; 5 microM and 250 microM: P<0.01, respectively) and 90% of MT (100 nM and 5 microM: P<0.05; 250 microM: P<0.01, respectively). LY294002 at 100 microM also attenuated SCS-induced vasodilation at 60% and 90% of MT (P<0.05). These data suggest that ERK and AKT pathways are involved in SCS-induced vasodilation.
    Brain Research 06/2008; 1207:73-83. DOI:10.1016/j.brainres.2007.12.072 · 2.84 Impact Factor
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    • "Shealy was the first to use SCS to treat pain patients (Shealy et al., 1967). Currently SCS is the most common neuromodulatory treatment for ischemic pain and the overall beneficial effects last for at least 1 year in 80% of patients, and last for up to 5 years in 60% of patients (Deer and Raso, 2006). It is estimated that each year more than 14,000 SCS implantations are performed worldwide (Linderoth and Foreman, 2006). "
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    ABSTRACT: Spinal cord stimulation (SCS) is a widely used clinical technique to treat ischemic pain in peripheral, cardiac and cerebral vascular diseases. The use of this treatment advanced rapidly during the late 80's and 90's, particularly in Europe. Although the clinical benefits of SCS are clear and the success rate remains high, the mechanisms are not yet completely understood. SCS at lumbar spinal segments (L2-L3) produces vasodilation in the lower limbs and feet which is mediated by antidromic activation of sensory fibers and decreased sympathetic outflow. SCS at thoracic spinal segments (T1-T2) induces several benefits including pain relief, reduction in both frequency and severity of angina attacks, and reduced short-acting nitrate intake. The benefits to the heart are not likely due to an increase, or redistribution of local blood flow, rather, they are associated with SCS-induced myocardial protection and normalization of the intrinsic cardiac nervous system. At somewhat lower cervical levels (C3-C6), SCS induces increased blood flow in the upper extremities. SCS at the upper cervical spinal segments (C1-C2) increased cerebral blood flow, which is associated with a decrease in sympathetic activity, an increase in vasomotor center activity and a release of neurohumoral factors. This review will summarize the basic science studies that have contributed to our understanding about mechanisms through which SCS produces beneficial effects when used in the treatment of vascular diseases. Furthermore, this review will particularly focus on the antidromic mechanisms of SCS-induced vasodilation in the lower limbs and feet.
    Autonomic Neuroscience 03/2008; 138(1-2):9-23. DOI:10.1016/j.autneu.2007.11.001 · 1.56 Impact Factor
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    ABSTRACT: Spinal cord stimulation (SCS) may be helpful in treating pain and vascular insufficiency associated with inoperable peripheral vascular disease (PVD). Often decision-making regarding progression from trial to implantation is based on subjective measures. Transcutaneous oxygen pressure, a measure of microcirculation and tissue perfusion, provides information on changes that may occur in PVD patients that undergo SCS trials and may provide predictive information for patient outcomes. This article reports on 2 patients with severe PVD in which transcutaneous oxygen pressures were measured during the trial phase, guided progression to implantation, and were followed in the postoperative period. Transcutaneous oxygen pressure values continued to improve following permanent implantation. We provide a review on transcutaneous oxygen pressure monitoring, along with emphasis on the technical aspects of transcutaneous oxygen pressure monitoring and its incorporation into practice. The decision to implant a SCS should be based on not only subjective measures of improvement, but also objective measures of improvement in transcutaneous oxygen pressure. Additional research is warranted to develop transcutaneous oxygen pressure predictive indices to assist in the selection of patients for progression to permanent implantation.
    Pain physician 01/2008; 11(6):909-16. · 3.54 Impact Factor
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