Although several drugs have been recently introduced on the market with the promise of controlling chronic neuropathic pain, a large number of them is ineffective on long term. These are the cases in whom the different neuromodulation procedures available have been adopted with relevant results.
Among them spinal cord stimulation is mainly used to treated the so called Failed Back Surgery Syndrome together with other sources of chronic neuropathic pain. Lead or paddle electrode are being placed on the posterior surface of the spinal dura and connected to an impulse generator creating an electric field that can interfere with the transmission of chronic pain along the spine thus reducing pain in at least 75% of the patients affected by this form of pain. Many other causes of chronic neuropathic paiin are observed and treated by both spinal cord stimulation both using tonic and burst patterns of stimulation, subcutaneous peripheral electric stimulation, Dorsal ganglion stimulation and deep brain stimulation. Moreover in those cases in whom a combination of neuropathic and nociceptive pain are observed intrathecal morphine can be used alone or in association with spinal cord stimulation. These neuromodulation procedures substitute the old neurosurgical lesional approaches consisting of the lesioning of both posterior nerve roots and DREZ lesioning.
More than 700 patients have been treated for their pain with neuromodulation procedures at the Fondazione Istituto Neurologico “C.Besta” and results have been reported in a number of papers.
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