{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:56:17Z","timestamp":1790369777610,"version":"4.1.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1991,9]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Epidural spinal cord stimulation by means of chronically implanted electrodes was carried out on 121 patients with pain of varied benign organic etiology. In 116 patients, the pain was confined to the back and lower extremities and, of these, 56 exhibited the failed-back syndrome. Most patients were referred by a pain management service because of failure of conventional pain treatment modalities. Electrodes were implanted at varying sites, dictated by the location of pain. A total of 140 epidural implants were used: 76 unipolar, 46 Resume electrodes, 12 bipolar, and six quadripolar. Patients were followed for periods ranging from 6 months to 10 years, with a mean follow-up period of 40 months. Forty-eight patients (40%) were able to control their pain by neurostimulation alone. A further 14 patients (12%), in addition to following a regular stimulation program, needed occasional analgesic supplements to achieve 50% or more relief of the prestimulation pain. Pain secondary to arachnoiditis or perineural fibrosis following multiple intervertebral disc operations, when predominantly confined to one lower extremity, seemed to respond favorably to this treatment. Uniformly good results were also obtained in lower-extremity pain secondary to multiple sclerosis. Pain due to advanced peripheral vascular disease of the lower limbs was well controlled, and amputation below the knee was delayed for up to 2 years in some patients. Pain due to cauda equina injury, paraplegic pain, phantom-limb pain, pure midline back pain without radiculopathy, or pain due to primary bone or joint disease seemed to respond less well. Patients who responded to preliminary transcutaneous electrical nerve stimulation generally did well with electrode implants. Notable complications included wound infection, electrode displacement or fracturing, and fibrosis at the stimulating tip of the electrode. Three patients in this series died due to unrelated causes. Epidural spinal cord stimulation has proven to be an effective and safe means of controlling pain on a long-term basis in selected groups of patients.<\/jats:p>\n<jats:p content-type=\"fine-print\">The mechanism of action of stimulation-produced analgesia remains unclear; further studies to elucidate it might allow spinal cord stimulation to be exploited more effectively in disorders that are currently refractory to this treatment modality.<\/jats:p>","DOI":"10.3171\/jns.1991.75.3.0402","type":"journal-article","created":{"date-parts":[[2009,5,19]],"date-time":"2009-05-19T16:16:37Z","timestamp":1242749797000},"page":"402-407","source":"Crossref","is-referenced-by-count":191,"title":["Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience"],"prefix":"10.3171","volume":"75","author":[{"given":"Krishna","family":"Kumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Nath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon M.","family":"Wyant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","first-page":"740","article-title":"Stimulation of internal capsule for relief of chronic pain.","volume":"41","author":"Adams","year":"1974"},{"key":"b2","series-title":"Ann Surg","first-page":"104","article-title":"Epidural electrical stimulation in severe limb ischemia: evidences of pain relief, increased blood flow and a possible limb saving effect.","volume":"202","author":"Augustinsson","year":"1985"},{"key":"b3","series-title":"Appl Neurophysiol","first-page":"456","article-title":"Epidural nerve stimulation of the lower spinal cord and cauda equina for the relief of intractable pain in failed back surgery.","volume":"45","author":"Blume","year":"1982"},{"key":"b4","series-title":"J Neurosurg","first-page":"71","article-title":"Spinal cord stimulation in peripheral arterial disease. A cooperative study.","volume":"64","author":"Broseta","year":"1986"},{"key":"b5","series-title":"Appl Neurophysiol","first-page":"190","article-title":"Chronic epidural dorsal column stimulation in the treatment of causalgic pain.","volume":"45","author":"Broseta","year":"1982"},{"key":"b6","series-title":"Pain","first-page":"87","article-title":"Assessment of chronic pain: aspects of reliability and validity of visual analogue scale.","volume":"16","author":"Carlsson","year":"1983"},{"key":"b7","series-title":"NY State J Med","first-page":"366","article-title":"Vascular disease of extremities. Electrical stimulation of spinal cord and posterior roots.","volume":"76","author":"Cook","year":"1976"},{"key":"b8","series-title":"South Med J","first-page":"1309","article-title":"Modification of blood flow to extremities by electrical stimulation of the nervous system.","volume":"69","author":"Dooley","year":"1976"},{"key":"b9","series-title":"Surg Neurol","first-page":"59","article-title":"Dorsal column stimulation for relief of intractable pain: problems encountered with neuropacemakers.","volume":"2","author":"Fox","year":"1974"},{"key":"b10","series-title":"Pain Measurement and Assessment.","first-page":"33","article-title":"Visual analogue scale","author":"Huskisson","year":"1983"},{"key":"b11","series-title":"J Neurosurg","first-page":"554","article-title":"Principles of pain management. A short review.","volume":"50","author":"King","year":"1979"},{"key":"b12","series-title":"Sixth International Congress of Neurological Surgery. International Congress Series 433.","first-page":"288","article-title":"Long-term results of spinal cord stimulation in amputees","author":"Krainick","year":"1977"},{"key":"b13","series-title":"J Neurosurg","first-page":"346","article-title":"Pain reduction in amputees by long-term spinal cord stimulation. Long-term follow-up study over 5 years.","volume":"52","author":"Krainick","year":"1980"},{"key":"b14","series-title":"Pain Clin","first-page":"91","article-title":"Epidural spinal cord stimulation for relief of chronic pain.","volume":"2","author":"Kumar","year":"1986"},{"key":"b15","series-title":"Neurostimulation: An Overview.","first-page":"5","article-title":"A brief historical review of biostimulation","author":"Lazorthes","year":"1985"},{"key":"b16","series-title":"Neurostimulation: An Overview.","first-page":"67","article-title":"Technical evolution and long-term results of chronic spinal cord stimulation","author":"Lazorthes","year":"1985"},{"key":"b17","series-title":"Appl Neurophysiol","first-page":"187","article-title":"Stimulation of the spinal neuraxis by biocompatible electrical current in the human.","volume":"44","author":"Le Roy","year":"1981"},{"key":"b18","series-title":"Mechanisms of Pain and Analgesic Compounds.","first-page":"51","article-title":"Current status of neuroaugmentation procedures for chronic pain","author":"Long","year":"1979"},{"key":"b19","series-title":"J Neurosurg","first-page":"718","article-title":"Electrical stimulation for relief of pain from chronic nerve injury.","volume":"39","author":"Long","year":"1973"},{"key":"b20","series-title":"Appl Neurophysiol","first-page":"207","article-title":"Electrical stimulation of the spinal cord and peripheral nerves for pain control. A ten-year experience.","volume":"44","author":"Long","year":"1981"},{"key":"b21","series-title":"J Neurosurg","first-page":"821","article-title":"Pain control and improvement of peripheral blood flow following epidural spinal cord stimulation. Case report.","volume":"54","author":"Meglio","year":"1981"},{"key":"b22","series-title":"J Neurosurg","first-page":"519","article-title":"Spinal cord stimulation in management of chronic pain. A 9-year experience.","volume":"70","author":"Meglio","year":"1989"},{"key":"b23","series-title":"Pain Measurement and Assessment.","first-page":"41","article-title":"The McGill Pain Questionnaire","author":"Melzack","year":"1983"},{"key":"b24","series-title":"J Neurosurg","first-page":"590","article-title":"Dorsal column stimulation for control of pain. Preliminary report on 30 patients.","volume":"36","author":"Nashold","year":"1972"},{"key":"b25","series-title":"J Neurosurg","first-page":"64","article-title":"Complications of dorsal column stimulation.","volume":"48","author":"Pineda","year":"1978"},{"key":"b26","series-title":"Surg Neurol","first-page":"157","article-title":"Dorsal column stimulation and its prospects.","volume":"4","author":"Pineda","year":"1975"},{"key":"b27","series-title":"Clin Neurosurg","first-page":"564","article-title":"Electrical and chemical stimulation of the CNS by direct means for pain control: present and future.","volume":"28","author":"Ray","year":"1981"},{"key":"b28","series-title":"Orthop Rev","first-page":"29","article-title":"New electrical stimulation methods for therapy and rehabilitation.","volume":"6","author":"Ray","year":"1977"},{"key":"b29","series-title":"Proceedings of Symposium: Indications for Spinal Cord Stimulation. Conducted at Seventh International Congress of Neurological Surgery, M\u00fcnchen.","first-page":"17","article-title":"Percutaneous spinal cord stimulation: technique","author":"Ray","year":"1981"},{"key":"b30","series-title":"Appl Neurophysiol","first-page":"194","article-title":"Spinal epidural electrical stimulation for pain control: practical details and results.","volume":"44","author":"Ray","year":"1981"},{"key":"b31","series-title":"Appl Neurophysiol","first-page":"160","article-title":"Neurostimulation as used in a large clinical practice.","volume":"45","author":"Ray","year":"1982"},{"key":"b32","series-title":"Neurosurgery","first-page":"63","article-title":"Scarring around cervical epidural stimulating electrode.","volume":"13","author":"Reynolds","year":"1983"},{"key":"b33","series-title":"Appl Neurophysiol","first-page":"50","article-title":"Technological problems of spinal cord stimulation systems: a clinical perspective.","volume":"44","author":"Sharkey","year":"1981"},{"key":"b34","series-title":"J Neurosurg","first-page":"560","article-title":"Dorsal column electroanalgesia.","volume":"32","author":"Shealy","year":"1970"},{"key":"b35","series-title":"Neural Organization and Its Relevance to Prosthetics.","first-page":"219","article-title":"Electrical stimulation for suppression of pain in man","author":"Sweet","year":"1973"},{"key":"b36","series-title":"Trans Am Neurol Assoc","first-page":"103","article-title":"Treatment of chronic pain by stimulation of fibers of primary afferent neurons.","volume":"93","author":"Sweet","year":"1968"},{"key":"b37","series-title":"J Neurol Neurosurg Psychiatry","first-page":"478","article-title":"Spinal cord stimulation in peripheral vascular disease.","volume":"46","author":"Tallis","year":"1983"},{"key":"b38","series-title":"J Neurosurg","first-page":"323","article-title":"Percutaneous epidural stimulation of the spinal cord for relief of pain. Long-term results.","volume":"48","author":"Urban","year":"1978"},{"key":"b39","series-title":"Arch Orthop Trauma Surg","first-page":"62","article-title":"Spinal cord stimulation in patients with a battered root syndrome.","volume":"104","author":"Waisbrod","year":"1985"},{"key":"b40","series-title":"Science","first-page":"108","article-title":"Temporary abolition of pain in man.","volume":"155","author":"Wall","year":"1967"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/75\/3\/article-p402.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/75\/3\/article-p402.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/75\/3\/article-p402.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T22:16:43Z","timestamp":1679264203000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/75\/3\/article-p402.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,9]]},"references-count":40,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/jns.1991.75.3.0402","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1991,9]]}}}