Narrative review of current neuromodulation modalities for spinal cord injury

Frontiers in Pain Research, 2023 · DOI: 10.3389/fpain.2023.1143405 · Published: March 9, 2023

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Neuromodulation, including therapies like TMS, tDCS, and SCS, is being explored for spinal cord injury (SCI) to manage pain and restore function. Spinal cord stimulation (SCS) is a technique that delivers electrical pulses to nerves along the spinal column through epidural electrodes, which modiﬁes nerve activity and minimizes the sensation of pain reaching the brain High-frequency SCS (HF-SCS) and burst SCS (B-SCS) are showing promise in improving pain intensity and frequency, while dorsal root ganglion stimulation (DRG-S) and TMS may enhance motor responses and limb strength.

Study Duration

Not specified

Participants

SCI patients

Evidence Level

Review

Key Findings

1
High-frequency spinal cord stimulation (HF-SCS) and burst spinal cord stimulation (B-SCS) have been shown to have the most promising effect in improving pain intensity and frequency.
2
Dorsal root ganglion stimulation (DRG-S) and TMS have been shown to effectively increase motor responses and improve limb strength.
3
Paresthesia-based SCS (P-SCS) has demonstrated potential efﬁcacy of this paradigm when addressing pain and other manifestations of SCI.

Research Summary

This review examines various neuromodulation modalities for managing pain and restoring function in SCI patients, highlighting the potential of HF-SCS and B-SCS for pain relief. DRG-S and TMS show promise in improving motor function and limb strength, while P-SCS has been studied most for nociceptive pain. The review emphasizes the need for more long-term, randomized controlled trials to validate the clinical efficacy of these emerging modalities in SCI patients.

Practical Implications

Pain Management

HF-SCS and B-SCS can potentially be used as future first-line treatment options for SCI patients struggling with refractory pain.

Motor Function Improvement

DRG-S and TMS have the potential to be used first as a means to improve a patient’s degree of disability and ability to perform activities of daily living.

Research Directions

Further large-scaled trials must be completed in order to determine the clinical efﬁcacy of each method and to determine what additional adjuvant therapies should be provided concomitantly in order to maximize their therapeutic effects.

Study Limitations

1
Lack of long-term, randomized controlled trials
2
Limited clinical research assessing the use of HF-SCS on SCI patients
3
Inconsistent results regarding the efﬁcacy of tDCS for functional motor recovery

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury