Spinal cord stimulation was based on the gate control theory of pain, and is now linked to many mechanisms. It is thought to activate spinal inhibitory circuits, mainly those concerned with g-aminobutyric acid (GABA)-ergic
mechanisms, [V], and may have a suppressive action on dorsal horn neuronal hyperexcitability.124 Before permanent implantation of a stimulation device, a trial period with temporary external stimulation is strongly recommended. Spinal cord stimulation has been shown to have long-term benefit in various conditions associated with neuropathic pain, including diabetic painful neuropathy, complex regional pain syndromes, and failed back syndrome.125[III], 126[III], 127[III], 128[III], 129[III], 130 [III], 131 Postherpetic pain and intercostal neuralgia seem to respond less favorably over the long term,126[III] as do pain due to cauda equina injury and phantom limb pain. [III] Strict criteria need to be applied to the * 16. selection of a patient, and all therapeutic modalities should be exhausted before the decision to implant a 17.
stimulator is made.
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