Electrical stimulation in the nervous system: The current status of electrical stimulation of the nervous system for relief of pain

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Abstract
Electrical stimulation of the afferent nervous system may be a very effective way to treat pain. Cutaneously applied electrodes, utilized empirically in pain areas of many origins, are satisfactory treatment for a large number of patients suffering from chronic intractable pain. The experience to date suggests that at least 25% of such patients are being treated by this technique alone and may not require more extensive therapy. Data available in the treatment of acute pain and in relatively minor pain states suggests that externally applied electrical stimulation is of more value in these fields that in the treatment of chronic pain. Stimulators implanted on peripheral nerves for pain of peripheral nerve injury origin are apparently very satisfactory and constitute 1 of the best ways of predictably relieving pain of this type. Peripheral nerve stimulation for pain related to but remote from the nerve involved is less predictable, but in carefully selected patients it can be highly effective. Dorsal column stimulation, even with careful selection, does not appear to be effective in more than 50% of patients on a long-term basis. Brain stimulation, a very promising but complex procedure with very real hazards, is currently restricted to use by a few surgeons for patients with central pain states. Current investigations include the design of electrodes and stimulators for external application of electricity, improvements in design for stimulators and electrodes for temporary use, investigation of stimulation of the anterior surface of the spinal cord and other brain areas for pain relief without paresthesias and improvement in the miniaturization of existing systems for peripheral nerve and spinal cord stimulation. The prgamatic effectiveness of these techniques appears to be well established; however, a comprehensive neurophysiological explanation for this effectiveness is not yet available.