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Electroacupuncture
Published in Andrew A. Marino, Modern Bioelectricity, 2020
The traditional theory of acupuncture is clearly inadequate to explain its effects. Many other explanations have been proposed, generally based on known or postulated neurophysio-logical mechanisms, or on the power of suggestion. The gate control theory is one example. First put forward by Melzack and Wall, it suggested that the perception of painful stimuli carried to the spinal cord can be blocked or masked by a different, non-painful stimulus (18). This is the basis for the current successful use of dorsal column stimulators for the relief of chronic pain (19). Similar phenomena include pain relief by counter-irritation, such as the application of hot and. cold packs, or direct cutaneous stimulation. Man and Chen proposed a “two-gate” theory of acupuncture analgesia, with a second gate in the thalamus (20,21), while Melzack suggested a modified gate control theory (22,23). Current Chinese explanations involve as many as four gates, located in the spinal cord, brain stem, thalamus, and cerebral cortex (3,24).
Medical device implants for neuromodulation
Published in Ze Zhang, Mahmoud Rouabhia, Simon E. Moulton, Conductive Polymers, 2018
In SCS, an electrode with an array of contacts is implanted in the dorsal epidural space of the spinal cord. Large myelinated primary afferent dorsal column fibers are depolarized and excited along the spinal cord near the electrode, leading to the propagation of action potentials. The activation of the dorsal column axons is thought to be responsible for the paresthesia experienced by patients during stimulation. Unfortunately, about one-third of patients do not respond to SCS (Wolter 2014). The efficacy of SCS should improve, however, as technology develops and the biology of pain is better understood.
Homo Sapiens (“Us”): Strengths and Weaknesses
Published in Michael Hehenberger, Zhi Xia, Huanming Yang, Our Animal Connection, 2020
Michael Hehenberger, Zhi Xia, Huanming Yang
The spinothalamic tract consists of two pathways, namely anterior and lateral. The anterior spinothalamic tract carries information about crude touch and firm pressure. The lateral spinothalamic tract conveys pain and temperature. Similarly, the dorsal column-medial lemniscus tract conveys sensory information from the periphery to the conscious level at the brain’s cerebral cortex.
Advanced methods of spinal stimulation in the treatment of chronic pain: pulse trains, waveforms, frequencies, targets, and feedback loops
Published in Expert Review of Medical Devices, 2019
Ankit Maheshwari, Jason E. Pope, Timothy R. Deer, Steven Falowski
The dorsal root ganglion houses primary sensory neurons of all modalities. It has been identified as an important site of aberrant activity in neuropathic pain. Electrical stimulation of the dorsal root ganglion has a potential to reduce neuronal excitability as well as modulating ectopic discharges. Since the time of our last review, there has been an increase in the application of dorsal root ganglion stimulation and clinical outcome studies have demonstrated its effectiveness for numerous chronic neuropathic pain conditions such as complex regional pain syndrome, post-herniorrhaphy groin pain, radicular pain (Table 6). Typically, this modality has been used for the treatment of distal neuropathic pain conditions which, in the past have been hard to treat with dorsal column stimulation.
Device profile of the Proclaim XR neurostimulation system for the treatment of chronic pain: an overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2020
Jonathan M. Hagedorn, Alyson M. Engle, Priyanka Ghosh, Timothy R. Deer
While there remains much to discover regarding the pain control mechanisms behind SCS, research has identified several possible etiologies. Originally known as ‘dorsal column stimulation,’ SCS involves the placement of electrodes over the dorsal aspect of the spinal cord in the epidural space. The axons of the large diameter afferent sensory neurons are found in this location. Stimulation of these axons in the dorsal column activates inhibitory interneurons which in turn attenuate spinal ascending pain transmission [2,3]. Specifically, this involves the laminae II dorsal horn through gamma-aminobutyric acid (GABA) [4].