It is generally agreed that electrical stimulation is effective in neurogenic forms of pain. Experiments indicate that electrical stimulation is followed by a decrease in the excitatory amino acids glutamate and aspartate in the dorsal horn. This effect is mediated by a GABAergic mechanism. In diabetic painful neuropathy that was unresponsive to drug treatment, electrical spinal cord stimulation (ESCS) with electrodes implanted between T9 and T11 resulted in a pain relief >50% in 8 of 10 patients. In addition, exercise tolerance was significantly improved. Complications of ESCS included superficial wound infection in two patients, lead migration requiring reinsertion in two patients, and "late failure" after 4 months in a patient who had initial pain relief (98). This invasive treatment option should be reserved for patients who do not respond to drug treatment.
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