Mechanisms and clinical progress of spinal cord stimulation in refractory chronic pain: an overview

Chronic pain is a major global health issue, affecting approximately 25% of the population. Managing this condition remains challenging due to the limited efficacy of current therapeutic options. Spinal cord stimulation (SCS), a form of neuromodulation, has been utilized to treat intractable visceral pain. This review summarizes recent advancements in understanding the effects and mechanisms of SCS in refractory chronic pain. Key mechanisms include neurotransmitter modulation, descending inhibition, and cortical changes. SCS operates through various modes, such as high-frequency, burst, closed-loop, dorsal horn inhibition, and descending control. Clinical indications for SCS encompass Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS), Painful Diabetic Peripheral Neuropathy (PDPN), ischemic pain, and cancer pain. This article aims to explore the clinical potential of SCS and the mechanisms underlying its therapeutic efficacy.