Mode of Action of Spinal Cord Stimulation in Neuropathic Pain Björn A. Meyerson, MD, PhD, Bengt Linderoth, MD, PhD  Journal of Pain and Symptom Management  Volume 31, Issue 4, Pages S6-S12 (March 2006) DOI: 10.1016/j.jpainsymman.2005.12.009 Copyright © 2006 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 1 Schematic representation of the possible mode of action of SCS in neuropathic pain, based on present knowledge derived predominantly from experiments performed on animal (rat) models of mononeuropathy (ref.,3 with permission). Both segmental and supraspinal mechanisms are represented. Possible supraspinal relays are not included because of insufficient knowledge about the organization of a proposed supraspinal loop. The broken arrow lines represent antidromic and full line arrows ortodromic activation in the DC, their collaterals and in primary A-afferents. The diagram does not depict a possible SCS activation of the DLF. It is conceivable that numerous transmitters and modulators are involved in the modulation exerted by interneurons (represented by “X”). Descending control of second order neurons is here represented as inhibitory only although there is evidence suggesting also a facilitatory supraspinal input (SP—substance P; EAA—excitatory amino acids [glutamate, aspartate]). Journal of Pain and Symptom Management 2006 31, S6-S12DOI: (10.1016/j.jpainsymman.2005.12.009) Copyright © 2006 U.S. Cancer Pain Relief Committee Terms and Conditions