![]() The dorsal horn of the human spinal cord is recognized as a key site for initial pain processing. However, in recent years, the attention of researchers has turned to non-axonal stimulation targets, such as dorsal columns, dorsal roots, and dorsal horns. Conventional techniques have focused on axons in the dorsal column. Technological advances in stimulator design and treatment protocols have not correlated with significant improvements in clinical outcomes, and we may be reaching the limits of what can be achieved using established techniques. 1 However, our incomplete understanding of the mechanisms underlying pain relief by SCS has led to a plateau in efficacy. Spinal cord stimulation (SCS) is an established technique for the treatment of chronic pain associated with many different disease entities, including neuropathic pain, intractable pain, headache, and angina pain, and its clinical efficacy is well documented. Wang CC, Willis WD Westlund KN (1999) Ascending projections from the area around the spinal cord central canal: A PHA-L study in rats.President, International Neuromodulation Societyĭirector of Hunter Pain Specialists, Hamilton Day Surgery Centre, Genesis Research Services, Broadmeadow, AustraliaĬo-Director, Innervate Pain Management Program, Newcastle, AustraliaĬhronic pain is a heterogenous, complex condition that is associated with significant burdens for both patients and the healthcare systems. Wang CC, Westlund KN (2001) Responses of rat dorsal column neurons to pancreatic nociceptive stimulation. Uddenberg N (1968) Functional organization of long, second-order afferents in the dorsal funiculus. Rustioni A, Hayes NL, O'Neill S (1979) Dorsal column nuclei and ascending spinal afferents in macaques. Rustioni,A (1973) Non-primary afferents to the nucleus gracilis from the lumbar cord of the cat. Ness TJ, Gebhardt GF (1987) Characterization of neuronal responses to noxious visceral and somatic stimuli in the medial lumbosacral spinal cord of the rat. Honda CN, Perl ER (1985) Functional and morphological features of neurons in the midline region of the caudal spinal cord of the cat. Honda CN, Lee CL (1985) Immunohistochemistry of synaptic input and functional characterizations of neurons near the spinal central canal. Honda CN (1985) Visceral and somatic afferent convergence onto neurons near the central canal in the sacral spinal cord of the cat. Evidence against an important role in nociception. Giesler GJ Jr, Cliffer KD (1985) Postsynaptic dorsal column pathway of the rat. J Neurosci 9:3146–3168įeng Y, Cui M, Al-Chaer ED, Willis WD (1998) Epigastric antinociception by cervical dorsal column lesions in rats. Distribution of ascending afferent fibers. J Physiol 337:575–588Ĭliffer KD, Giesler GJ Jr (1989) Postsynaptic dorsal column pathway of the rat. (1983) Receptive field organization and response properties of spinal neurones with axons ascending the dorsal columns in the cat. Exp Brain Res 22:457–470īerkeley KJ, Hubscher CH (1995) Are there separate central nervous system pathways for touch and pain? Nat Med 1:766–773.īrown AG, Brown PB, Fyffe RE et al. Existence of long ascending postsynaptic fibres in the cat's fasciculus gracilis. J Neurophysiol 76:2675–2690Īngaut-Petit D (1975) The dorsal column system: I. (1996) Pelvic visceral input into the nucleus gracilis is largely mediated by the postsynaptic dorsal column pathway. ![]() Al-Chaer ED, Lawand NB, Westlund KN et al.
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