Pharmacologically enhanced spinal cord stimulation for pain: an evolving strategy

SUMMARY Spinal cord stimulation (SCS) as treatment for chronic neuropathic pain has developed into an important therapeutic strategy. However, several studies indicate that as many as 30-50% of patients do not respond sufficiently to technically well-functioning SCS. Experimental studies have revealed some of the possible neuronal systems and transmitters involved in SCS. Based on such data, a new strategy has been suggested: "pharmacologically enhanced spinal cord stimulation" using receptor active drugs to improve the therapeutic effect. The present article reviews the animal data on which clinical trials have been based and summarizes the clinical experience up to the present. Relevant data exist for intrathecal baclofen as an adjuvant to SCS, but trials with clonidine and adenosine have also been performed. Available basic studies indicate that other substances might also prove useful in future trials. The present data thus only announce the beginning of 'drug-enhanced spinal stimulation'.