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A literature review and synthesis were performed.To present the current understanding of the mechanisms of spinal cord stimulation in relation to the physiology of pain,Spinal cord stimulation has been used for more than 30 years in the armamentarium of the interventional pain specialist to treat a variety of pain syndromes. Traditionally used for persisting leg pain after lumbar spinal surgery, it has been applied successfully in the treatment of angina pectoris, ischemic pain in the extremity, complex regional pain syndrome Types 1 and 2, and a variety of other pain states. This review presents the current status of what is known concerning how electrical stimulation of the spinal cord may achieve pain relief.A literature review was conducted.The literature supports the theory that the mechanism of spinal cord stimulation cannot be completely explained by one model. It is likely that multiple mechanisms operate sequentially or simultaneously.Some clinical or experimental support can be found in the literature for 10 specific mechanisms or proposed mechanisms of spinal cord stimulation.