More information about text formats
The dorsal horns are not merely passive transmission stations but
sites at which dynamic activities (inhibition, excitation and modulation)
Via a series of filters and amplifiers, the nociceptive message is
integrated and analysed in the cerebral cortex, with interconnections with
various areas. 
The processing of pain takes place in an integrated matrix throughout...
The processing of pain takes place in an integrated matrix throughout
the neuroaxis and occurs on at least three levels, at peripheral, spinal,
and supraspinal sites. 
Knowledge of the modalities of pain control is essential to correctly
adapt treatment strategies (drugs, neurostimulation, psycho-behavioural
Dysfunction of pain control systems causes neuropathic pain. 
Spinal Cord Stimulation modalities evolved from the gate-control
theory postulating a spinal modulation of noxious inflow.   
         
It has been demonstrated in multiple studies that dorsal horn
neuronal activity caused by peripheral noxious stimuli could be inhibited
by concomitant stimulation of the dorsal columns. 
Pain relief was more prominent at pain ascending through C fibers
than pain ascending through Adelta fibers 
Many theories on the mechanism of action of Spinal Cord Stimulation
have been suggested, including activation of gate control mechanisms,
conductance blockade of the spinothalamic tracts, activation of
supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms,
and activation or release of putative neuromodulators. 
At present, Spinal Cord Stimulation is a well established form of
treatment for failed back surgery syndrome, complex regional pain
syndromes (CRPS), low back pain with radiculopathy and refractory pain due
to ischemia.    
Stimulation produced analgesia can provide a level of analgesia and
efficacy that is unattainable by other treatment modalities. 
Spinal Cord Stimulation for the treatment of chronic pain is cost-
effective when used in the context of a pain treatment continuum. 
Precise subcutaneous field stimulation is targeted to specific areas
of neuropathic pain. 
We aim at attenuation or blockade of pain through intervention at the
periphery, by activation of inhibitory processes that gate pain at the
spinal cord and brain. 
Segmental noxious stimulation produces a stronger analgesic effect
than segmental innocuous stimulation. 
That is exactly what intradermal sterile water or subcutaneous saline
Chloride, used in subcutaneous "sham" injections, independently
regulates the pain pathway. 
In these studies there was no valid control group receiving sham
In the past, other researchers, in similar studies, have also had
difficulties in blinding and comparing with control groups. 
These RCTs simply compared an established therapeutic intervention to
another established therapeutic intervention.
 Labat JJ, Robert R, Delavierre D, et al. Anatomy and physiology of chronic pelvic and perineal pain. Prog Urol 2010;20(12):843-52. Epub 2010 Oct 20.
 Moharic M, Burger H. Effect of transcutaneous electrical nerve stimulation on sensation
thresholds in patients with painful diabetic neuropathy: an observational
study. Int J Rehabil Res 2010;33(3):211-7.
 Shrivastav M, Musley S. Spinal cord stimulation for complex regional pain syndrome.
Conf Proc IEEE Eng Med Biol Soc 2009;2009:2033-6.
 Kunnumpurath S, Srinivasagopalan R, Vadivelu N. Spinal cord stimulation: principles of past, present and future practice:
a review. J Clin Monit Comput 2009;23(5):333-9.
 Price TJ, Cervero F, Gold MS, et al. Chloride regulation in the pain pathway. Brain Res Rev 2009;60(1):149-70. Epub 2008 Dec 31.
 Henderson JM. Peripheral nerve stimulation for chronic pain. Curr Pain Headache Rep 2008;12(1):28-31.
 Handwerker HO. From Descartes to fMRI. Pain theories and pain concepts. Schmerz 2007;21(4):307-10, 312-7.
 Stojanovic MP, Abdi S. Spinal cord stimulation. Pain Physician 2002;5(2):156-66.
 DeLeo JA. Basic science of pain. J Bone Joint Surg Am 2006;88 Suppl 2:58-62.
 Defrin R, Ariel E, Peretz C. Segmental noxious versus innocuous electrical stimulation for chronic pain
relief and the effect of fading sensation during treatment. Pain 2005;115(1-2):152-60.
 Craig AD. Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci 2003;26:1-30. Epub 2003 Mar 6.
 Staal JB, Hlobil H, van Tulder MW, et al. Return-to-work interventions for low back pain: a descriptive review of
contents and concepts of working mechanisms. Sports Med 2002;32(4):251-67.
 Stojanovic MP. Stimulation methods for neuropathic pain control. Curr Pain Headache Rep 2001;5(2):130-7.
 Krames E. Spinal Cord Stimulation: Indications, Mechanism of Action, and Efficacy. Curr Rev Pain 1999;3(6):419-426.
 Costentin J. Pain and its main transmitters. Ann Pharm Fr 2000;58(2):77-83.
 Meyerson BA, Linderoth B. Mechanisms of spinal cord stimulation in neuropathic pain. Neurol Res 2000;22(3):285-92.
 Yaksh TL. Regulation of spinal nociceptive processing: where we went when we
wandered onto the path marked by the gate. Pain 1999;Suppl 6:S149-52.
 Melzack R. From the gate to the neuromatrix. Pain 1999;Suppl 6:S121-6.
 Stanton-Hicks M, Salamon J. Stimulation of the central and peripheral nervous system for the control
of pain. J Clin Neurophysiol. 1997;14(1):46-62.
 Humphries SA, Johnson MH, Long NR. An investigation of the gate control theory of pain using the experimental
pain stimulus of potassium iontophoresis. Percept Psychophys 1996 ;58(5):693-703.
 Kakigi R, Watanabe S. Pain relief by various kinds of interference stimulation applied to the
peripheral skin in humans: pain-related brain potentials following CO2
laser stimulation. J Peripher Nerv Syst. 1996;1(3):189-98.
 Davis P. Pain: opening up the gate control theory. Nurs Stand. 1993;7(45):25-7.
 Cambier J. Gate control of the nociceptive message: applications to the treatment of pain. Bull Acad Natl Med 1989;173(7):855-60; discussion 860-1.
 Benabid AL, Henriksen SJ, McGinty JF, et al. Thalamic nucleus ventro-postero-lateralis inhibits nucleus
parafascicularis response to noxious stimuli through a non-opioid pathway. Brain Res 1983;280(2):217-31.
 Malow RM, Dougher MJ. A signal detection analysis of the effects of transcutaneous stimulation
on pain. Psychosom Med. 1979 Mar;41(2):101-8.
 Goldman DE. Gate control of ion flux in axons. J Gen Physiol 1965;48:SUPPL:75-7.