Spinal cord stimulation: a nonopioid alternative for chronic pain management

Chronic pain affects 1 in 5 Canadians and is associated with considerable socioeconomic burden. Although opioids have been the mainstay of treatment, they have lost favourability owing to crises of addiction, abuse, tolerance and dependence. Consequently, alternatives--including cognitive behavioural therapy, physical rehabilitation, non-opiate pharmacology and integrative therapies - have been developed.1,3 When conventional therapies produce unacceptable adverse effects or do not provide sufficient pain relief, spinal cord stimulation (neuromodulation) may offer a rescue option, either alone or in conjunction with other modalities. Neuromodulation, defined as the alteration of nerve activity through targeted stimulus delivery, was first introduced in 1967. It is based on the principle of electrically stimulating the dorsal column of the spinal cord, to mask pain signals. The technology has since advanced, and it was a Canadian neurosurgeon who helped demonstrate both the efficacy and cost-effectiveness of spinal cord stimulation in chronic pain treatment.