Current status and future perspectives of spinal cord stimulation in treatment of chronic pain
In 1959, the neurosurgeon Willem Noordenbos30 reported that a signal carried along large diameter fibers for “touch, pressure or vibration” may inhibit the signal carried by the thinner “pain” fibers. Consequently, the concept of interaction between thick nonnociceptive fibers and thin nociceptive fibers, and the control of this at the spinal dorsal horn, was born. From this, Melzack and Wall introduced the “Gate-control” theory of pain.24,25 This gate theory postulates that stimulation of large myelinated fibers suppresses the response of dorsal horn neurons to input from small, unmyelinated peripheral pain fibers and provided the theoretical foundation for the use of spinal cord stimulation (SCS) as a clinical treatment for chronic pain. The experimental clinical use of SCS was first reported 2 years after the introduction of the classical gate-control theory.36 The first fully implantable SCS system was developed in 1970;35 the first clinical trials in patients suffering from intractable chronic pain were performed in the early seventies.