California Society of Anesthesiologists Bulletin Fall 2012 - (Page 42)

EducAtioNAl ArticlE Spinal Cord Stimulation Bianca Tribuzio, DO, Steven English, MD, Damien Tavares, MD, Danielle Perret Karimi, MD, and Justin Hata, MD Editor’s note: This educational article is reprinted from a CME module on the CSA website as a service to CSA members who prefer to study CME material via print media. The CME credit associated with the article is provided as a free benefit. In order to claim CME credit, the reader MUST visit www.csahq.org/onlineCME, select Pain Management and End-ofLife Care, and complete the Spinal Cord Stimulation Test Questions at the end of the module. For convenience, the same questions are printed at the end of the educational article here in the Bulletin. Do NOT submit the Answer Worksheet to the CSA; any answers recorded on the Answer Worksheet will need to be transferred to the quiz at the end of the online module. Bianca Tribuzio, DO, is chief resident in the Department of Physical Medicine & Rehabilitation, the University of California, Irvine, Medical Center (UCIMC). Steven English, MD, practices physical medicine and rehabilitation at The Everett Clinic, Everett, Wash. Damien Tavares, MD, is a staff physician for the Interdisciplinary Pain Management Center at Tripler Army Medical Center in Honolulu, Hawaii. Danielle Perret Karimi, MD, is Assistant Dean for Resident Affairs in Graduate Medical Education and Assistant Clinical Professor in the Departments of Anesthesiology & Perioperative Care and Physical Medicine & Rehabilitation at UCI. She is the Program Director for the multidisciplinary Fellowship Training Program in Pain Medicine and the Associate Program Director for the residency program in Physical Medicine & Rehabilitation. Dr. Karimi is an interventional pain physician at the Center for Pain Management, UCI. Justin Hata, MD, is Chief, UCI Pain Medicine Division, Department of Anesthesiology & Perioperative Care, and Interim Chair, Department of Physical Medicine & Rehabilitation, UCIMC. introduction Chronic pain is among the most common symptoms for which patients seek relief and its alleviation is among a physician’s traditional duties. The International Association for the Study of Pain defines chronic pain as lasting “beyond the usual course of the acute disease or expected time of healing. It may continue indefinitely.” The same source defines intractable pain as “that [which] is not relieved despite appropriate treatment”.9 This article discusses the use of electricity to treat pain, for which the earliest reported use was in 15 AD by Scribonius Largus, a Roman physician and pharmacologist, who advocated applying live torpedo fish to painful body parts.14, 36 As an outgrowth of the Malzack – Wall Gate Control Theory, Shealy and Mortimer published the first article describing the relief of chronic pain by electrical stimulation of the spinal cord in 1967.38 The technique involved surgically implanting electrodes over the dorsal columns after laminectomy with the aim of activating pain-inhibiting mechanisms and, therefore, was termed dorsal column stimulation. However, it was later determined that stimulation by electrodes percutaneously inserted into the epidural space were also effective in relieving pain. Further, technological advances in the system allowed clinicians to effectively target a greater variety of sites within the intraspinal canal including the dorsal root entry zone, dorsal root ganglion, and the spinal nerve roots. For these reasons, many authorities favor the term spinal cord stimulation (SCS).6,7 42 | CSA Bulletin  http://www.csahq.org/onlineCME

Table of Contents for the Digital Edition of California Society of Anesthesiologists Bulletin Fall 2012

A New Look, a Continuing Commitment
Jack L. Moore, MD, FACA (1934-2012)
Time to Reevaluate...
Politics and the 2012 California Legislative Session
Report from the Legislative and Practice Affairs Devision
Money Well Spent for Your MD Degree? Maybe!
Atul Gawande, MD, Advocates 'Cheesecake Factory' Medicine
The Cheesecake Cocktail
Autumn 2012 Report
2013 Winter Anesthesia Seminar
The Department of Anesthesia and Perioperative Care at the University of California, San Francisco: A Brief Historical Overview
The 2012 Spring Anesthesia Seminar
California and National News
Spinal Cord Stimulation

California Society of Anesthesiologists Bulletin Fall 2012

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