Improving lifestyle factors, such as appropriate weight management, regular physical activity, good mental and emotional health, proper nutrition, and healthy sleep habits are often helpful in promoting recovery. In most situations, non-surgical treatments should be used first during the evaluation and treatment of chronic pain. There is not a single treatment plan that will work for all patients and many patients will need several different approaches. The best treatment is found by understanding the cause of the nerve injury and using therapy that will correct the problem or reduce its effect. The source of the pain may be specific to one area or it may be wide spread. Spinal cord stimulation is most useful for injury to the nerve, which causes this type of chronic pain.įinding the most effective treatment option for a patient requires understanding the location where the pain is starting and the type of injury that has occurred. Chronic pain results when the pain continues even after the initial cause is no longer present. It is important to understand that a person can experience periods of nearly constant acute pain related to muscle or joint injury, arthritis, and many other medical conditions. With so many potential causes of chronic pain, the evaluation and treatment for one chronic pain patient may be very different from another similar patient. A person’s mental health can also play a role in the perception of pain and the ability to manage it. A pinched nerve in the back, uncontrolled diabetes, or a medical procedure are a few things that can result in chronic pain. Trauma to the body, as well as other medical conditions or medications can cause injury to nerves. Depending on the location of the nerve injury, this pain can feel differently. Nearly any injury to a nerve has the ability to become a chronic problem. © 2016 International Neuromodulation Society.Chronic pain can develop for many reasons. The larger fibers that cause paresthesia in low-frequency simulation are blocked, while medium and smaller fibers are recruited, leading to paresthesia-free neuropathic pain relief by inhibiting WDR cells.ġ0 kHz HF10 High-frequency stimulation chronic pain mechanisms nociceptive pain paresthesia spinal cord stimulation. These effects are a result of interaction between ion gate dynamics and the "activating function" (AF) deriving from current distribution over the axon. Simulations show both ion channel gate and virtual anode dynamics are necessary.Īt clinical HFS frequencies and pulse widths, HFS preferentially blocks larger-diameter fibers and concomitantly recruits medium and smaller fibers. We input field potential values from a finite element model of SCS into an active axon model with ion channel subcomponents for fiber diameters 1-20 µm and simulated dynamics on a 0.001 msec time scale.Īssuming some degree of wave rectification seen at the axon, action potential (AP) blockade occurs as hypothesized, preferentially in larger over smaller diameters with blockade in most medium and large diameters occurring between 4.5 and 10 kHz. Our hypothesis is that HFS preferentially blocks larger diameter axons (12-15 µm) based on dynamics of ion channel gates and the electric potential gradient seen along the axon, resulting in inhibition of WDR cells without paresthesia. Newer stimulation paradigms use high-frequency stimulation (HFS) up to 10 kHz and produce pain relief but without paresthesia. Typical SCS uses frequencies from 50-100 Hz. Spinal cord stimulation (SCS) treats neuropathic pain through retrograde stimulation of dorsal column axons and their inhibitory effects on wide dynamic range (WDR) neurons.
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