Skip to main content
SpringerLink
Log in
Book cover

Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches pp 689–696Cite as

Clinical Applications of Neuromodulation: Spinal Cord Stimulation for Abdominal Pain

  • Chapter
  • First Online:

Abstract

Chronic abdominal pain poses significant challenges to patients and physicians alike. For patients, pain can limit both professional and personal quality of life. It results in increased doctor visits, imaging and surgery interventions that frequently fail to find a cause or provide relief. For physicians, identification of etiology is fraught with difficulty, largely due to the fact that visceral pain is frequently diffuse and is poorly localized and referred to somatic structures. Abdominal pain is one of the most common complaints for primary care visits and is the leading reason for gastroenterological consultation. These challenges taken together with the high prevalence, frequent office visits and extensive work-up, as well as decreases in productivity, work hours, and socioeconomic status, make chronic abdominal pain a significant burden on the patient, physician, healthcare system, and society as a whole. In the United States alone, between 20 and 45 % of Americans will suffer from chronic visceral pain, of these only 50–70 % will have a definitive etiology of their pain identified. Recent research has provided data helping to better elucidate visceral pain pathways and the dorsal column’s role in not only transmission but also amplification of visceral pain. Exciting data in both animal models and human subjects has demonstrated that spinal cord stimulation of the dorsal horn can provide analgesia for chronic visceral pain and improve both quality of life and functional status.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Pare P, et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clin Ther. 2006;28(10):1726–35; discussion 1710–1.

    Article  PubMed  Google Scholar 

  2. Derbyshire SW. Imaging visceral pain. Curr Pain Headache Rep. 2007;11(3):178–82.

    Article  PubMed  Google Scholar 

  3. Russo MW, et al. Digestive and liver diseases statistics, 2004. Gastroenterology. 2004;126(5):1448–53.

    Article  PubMed  Google Scholar 

  4. Giamberardino MA, Vecchiet L. Pathophysiology of visceral pain. Curr Pain Headache Rep. 1997;1(1):23–33.

    Article  Google Scholar 

  5. Grundy D. Neuroanatomy of visceral nociception: vagal and splanchnic afferent. Gut. 2002;51 Suppl 1:i2–5.

    Article  PubMed  Google Scholar 

  6. Everhart J. Digestive diseases in the United States: epidemiology and impact, P.H.S. US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases, NIH publication No. 94–1447. p. 3–53.

    Google Scholar 

  7. Graney DO. General considerations of abdominal pain. In: Loesser JD, editor. Bonica’s management of pain. Philadelphia: Lippincott, Williams & Williams; 2001. p. 1235–68.

    Google Scholar 

  8. Klinkman MS. Episodes of care for abdominal pain in a primary care practice. Arch Fam Med. 1996;5(5):279–85.

    Article  PubMed  CAS  Google Scholar 

  9. Camilleri M, Ford MJ. Functional gastrointestinal disease and the autonomic nervous system: a way ahead? Gastroenterology. 1994;106(4):1114–8.

    PubMed  CAS  Google Scholar 

  10. Mayer EA, Raybould HE. Role of visceral afferent mechanisms in functional bowel disorders. Gastroenterology. 1990;99(6):1688–704.

    PubMed  CAS  Google Scholar 

  11. Elsenbruch S. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain Behav Immun. 2011;25(3):386–94.

    Article  PubMed  CAS  Google Scholar 

  12. Mertz H. Review article: visceral hypersensitivity. Aliment Pharmacol Ther. 2003;17(5):623–33.

    Article  PubMed  CAS  Google Scholar 

  13. Wood JD. Neuropathophysiology of irritable bowel syndrome. J Clin Gastroenterol. 2002;35(1 Suppl):S11–22.

    Article  PubMed  Google Scholar 

  14. Wood JD. Neuropathophysiology of functional gastrointestinal disorders. World J Gastroenterol. 2007;13(9):1313–32.

    PubMed  CAS  Google Scholar 

  15. Gebhart GF. Visceral pain-peripheral sensitisation. Gut. 2000;47 Suppl 4:iv54–5; discussion iv58.

    PubMed  Google Scholar 

  16. Gebhart GF. Pathobiology of visceral pain: molecular mechanisms and therapeutic implications IV. Visceral afferent contributions to the pathobiology of visceral pain. Am J Physiol Gastrointest Liver Physiol. 2000;278(6):G834–8.

    PubMed  CAS  Google Scholar 

  17. Cervero F, Janig W. Visceral nociceptors: a new world order? Trends Neurosci. 1992;15(10):374–8.

    Article  PubMed  CAS  Google Scholar 

  18. Kasparov SA. Viscerosomatic convergence on the lumbar interneurons of the dorsal horn of the spinal cord in cats and rats. Neirofiziologiia. 1992;24(1):3–11.

    PubMed  CAS  Google Scholar 

  19. Milne RJ, et al. Convergence of cutaneous and pelvic visceral nociceptive inputs onto primate spinothalamic neurons. Pain. 1981;11(2):163–83.

    Article  PubMed  CAS  Google Scholar 

  20. D’Mello R, Dickenson AH. Spinal cord mechanisms of pain. Br J Anaesth. 2008;101(1):8–16.

    Article  PubMed  Google Scholar 

  21. Wall PD, Woolf CJ. The brief and the prolonged facilitatory effects of unmyelinated afferent input on the rat spinal cord are independently influenced by peripheral nerve section. Neuroscience. 1986;17(4):1199–205.

    Article  PubMed  CAS  Google Scholar 

  22. Woolf CJ, Fitzgerald M. The properties of neurons recorded in the superficial dorsal horn of the rat spinal cord. J Comp Neurol. 1983;221(3):313–28.

    Article  PubMed  CAS  Google Scholar 

  23. Millan MJ. Descending control of pain. Prog Neurobiol. 2002;66(6):355–474.

    Article  PubMed  CAS  Google Scholar 

  24. Price DD, et al. Peripheral and central contributions to hyperalgesia in irritable bowel syndrome. J Pain. 2006;7(8):529–35.

    Article  PubMed  Google Scholar 

  25. Cervero F, Laird JM, Pozo MA. Selective changes of receptive field properties of spinal nociceptive neurons induced by noxious visceral stimulation in the cat. Pain. 1992;51(3):335–42.

    Article  PubMed  CAS  Google Scholar 

  26. Hylden JL, et al. Expansion of receptive fields of spinal lamina I projection neurons in rats with unilateral adjuvant-induced inflammation: the contribution of dorsal horn mechanisms. Pain. 1989;37(2):229–43.

    Article  PubMed  CAS  Google Scholar 

  27. Ness TJ, Metcalf AM, Gebhart GF. A psychophysiological study in humans using phasic colonic distension as a noxious visceral stimulus. Pain. 1990;43(3):377–86.

    Article  PubMed  CAS  Google Scholar 

  28. Verne GN, et al. Central representation of visceral and cutaneous hypersensitivity in the irritable bowel syndrome. Pain. 2003;103(1–2):99–110.

    Article  PubMed  Google Scholar 

  29. Verne GN, Robinson ME, Price DD. Hypersensitivity to visceral and cutaneous pain in the irritable bowel syndrome. Pain. 2001;93(1):7–14.

    Article  PubMed  CAS  Google Scholar 

  30. Palecek J, Paleckova V, Willis WD. Fos expression in spinothalamic and postsynaptic dorsal column neurons following noxious visceral and cutaneous stimuli. Pain. 2003;104(1–2):249–57.

    Article  PubMed  CAS  Google Scholar 

  31. Palecek J, Willis WD. The dorsal column pathway facilitates visceromotor responses to colorectal distention after colon inflammation in rats. Pain. 2003;104(3):501–7.

    Article  PubMed  CAS  Google Scholar 

  32. Al-Chaer ED, Feng Y, Willis WD. A role for the dorsal column in nociceptive visceral input into the thalamus of primates. J Neurophysiol. 1998;79(6):3143–50.

    PubMed  CAS  Google Scholar 

  33. Ishigooka M, et al. Spinal NK1 receptor is upregulated after chronic bladder irritation. Pain. 2001;93(1):43–50.

    Article  PubMed  CAS  Google Scholar 

  34. Okano S, Ikeura Y, Inatomi N. Effects of tachykinin NK1 receptor antagonists on the viscerosensory response caused by colorectal distention in rabbits. J Pharmacol Exp Ther. 2002;300(3):925–31.

    Article  PubMed  CAS  Google Scholar 

  35. Palecek J, Paleckova V, Willis WD. Postsynaptic dorsal column neurons express NK1 receptors following colon inflammation. Neuroscience. 2003;116(2):565–72.

    Article  PubMed  CAS  Google Scholar 

  36. Wu J, et al. The role of c-AMP-dependent protein kinase in spinal cord and post synaptic dorsal column neurons in a rat model of visceral pain. Neurochem Int. 2007;50(5):710–8.

    Article  PubMed  CAS  Google Scholar 

  37. Polgar E, et al. GABAergic neurons that contain neuropeptide Y selectively target cells with the neurokinin 1 receptor in laminae III and IV of the rat spinal cord. J Neurosci. 1999;19(7):2637–46.

    PubMed  CAS  Google Scholar 

  38. Feng Y, et al. Epigastric antinociception by cervical dorsal column lesions in rats. Anesthesiology. 1998;89(2):411–20.

    Article  PubMed  CAS  Google Scholar 

  39. Houghton AK, Kadura S, Westlund KN. Dorsal column lesions reverse the reduction of homecage activity in rats with pancreatitis. Neuroreport. 1997;8(17):3795–800.

    Article  PubMed  CAS  Google Scholar 

  40. Gildenberg PL, Hirshberg RM. Limited myelotomy for the treatment of intractable cancer pain. J Neurol Neurosurg Psychiatry. 1984;47(1):94–6.

    Article  PubMed  CAS  Google Scholar 

  41. Becker R, Sure U, Bertalanffy H. Punctate midline myelotomy. A new approach in the management of visceral pain. Acta Neurochir (Wien). 1999;141(8):881–3.

    Article  CAS  Google Scholar 

  42. Hirshberg RM, et al. Is there a pathway in the posterior funiculus that signals visceral pain? Pain. 1996;67(2–3):291–305.

    Article  PubMed  CAS  Google Scholar 

  43. Hwang SL, et al. Punctate midline myelotomy for intractable visceral pain caused by hepatobiliary or pancreatic cancer. J Pain Symptom Manage. 2004;27(1):79–84.

    Article  PubMed  Google Scholar 

  44. Kim YS, Kwon SJ. High thoracic midline dorsal column myelotomy for severe visceral pain due to advanced stomach cancer. Neurosurgery. 2000;46(1):85–90; discussion 90–2.

    Article  PubMed  CAS  Google Scholar 

  45. Nauta HJ, et al. Surgical interruption of a midline dorsal column visceral pain pathway. Case report and review of the literature. J Neurosurg. 1997;86(3):538–42.

    Article  PubMed  CAS  Google Scholar 

  46. Nauta HJ, et al. Punctate midline myelotomy for the relief of visceral cancer pain. J Neurosurg. 2000;92(2 Suppl):125–30.

    PubMed  CAS  Google Scholar 

  47. Ness TJ. Evidence for ascending visceral nociceptive information in the dorsal midline and lateral spinal cord. Pain. 2000;87(1):83–8.

    Article  PubMed  CAS  Google Scholar 

  48. Palecek J. The role of dorsal columns pathway in visceral pain. Physiol Res. 2004;53 Suppl 1:S125–30.

    PubMed  Google Scholar 

  49. Krames ES, Foreman R. Spinal cord stimulation modulates visceral nociception and hyperalgesia via the spinothalamic tracts and the postsynaptic dorsal column pathways: a literature review and hypothesis. Neuromodulation. 2007;10(3):224–37.

    Article  PubMed  Google Scholar 

  50. North RB, Kidd DH, Piantadosi S. Spinal cord stimulation versus reoperation for failed back surgery syndrome: a prospective, randomized study design. Acta Neurochir Suppl. 1995;64:106–8.

    Article  PubMed  CAS  Google Scholar 

  51. Kumar K, Nath RK, Toth C. Spinal cord stimulation is effective in the management of reflex sympathetic dystrophy. Neurosurgery. 1997;40(3):503–8; discussion 508–9.

    PubMed  CAS  Google Scholar 

  52. Stanton-Hicks M. Complex regional pain syndrome: manifestations and the role of neurostimulation in its management. J Pain Symptom Manage. 2006;31(4 Suppl):S20–4.

    Article  PubMed  Google Scholar 

  53. Jivegard LE, et al. Effects of spinal cord stimulation (SCS) in patients with inoperable severe lower limb ischaemia: a prospective randomised controlled study. Eur J Vasc Endovasc Surg. 1995;9(4):421–5.

    Article  PubMed  CAS  Google Scholar 

  54. Reig E, et al. Spinal cord stimulation in peripheral vascular disease: a retrospective analysis of 95 cases. Pain Pract. 2001;1(4):324–31.

    Article  PubMed  CAS  Google Scholar 

  55. Linderoth B, Foreman R. Mechanisms of spinal cord stimulation in painful syndromes: role of animal models. Pain Med. 2006;7 Suppl 1:S14–26.

    Article  Google Scholar 

  56. Saade NE, et al. Inhibition of nociceptive evoked activity in spinal neurons through a dorsal column-brainstem-spinal loop. Brain Res. 1985;339(1):115–8.

    Article  PubMed  CAS  Google Scholar 

  57. Linderoth B, Meyerson BA. Physiology of spinal cord stimulation: mechanism of action. In: Burchiel K, editor. Surgical management of pain. Stuttgart: Thieme Medical Publisher Inc; 2002. p. 505–26.

    Google Scholar 

  58. Cui JG, et al. Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain. 1997;73(1):87–95.

    Article  PubMed  CAS  Google Scholar 

  59. Linderoth B, et al. Gamma-aminobutyric acid is released in the dorsal horn by electrical spinal cord stimulation: an in vivo microdialysis study in the rat. Neurosurgery. 1994;34(3):484–8; discussion 488–9.

    Article  PubMed  CAS  Google Scholar 

  60. Campbell JN. Examination of possible mechanisms by which stimulation of the spinal cord in man relieves pain. Appl Neurophysiol. 1981;44(4):181–6.

    PubMed  CAS  Google Scholar 

  61. Larson SJ, et al. Neurophysiological effects of dorsal column stimulation in man and monkey. J Neurosurg. 1974;41(2):217–23.

    Article  PubMed  CAS  Google Scholar 

  62. Kapural L, et al. Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain. Pain Med. 2006;7(5):440–3.

    Article  PubMed  Google Scholar 

  63. Linderoth B, Fedorcsak I, Meyerson BA. Peripheral vasodilatation after spinal cord stimulation: animal studies of putative effector mechanisms. Neurosurgery. 1991;28(2):187–95.

    Article  PubMed  CAS  Google Scholar 

  64. Steege JF. Superior hypogastric block during microlaparoscopic pain mapping. J Am Assoc Gynecol Laparosc. 1998;5(3):265–7.

    Article  PubMed  CAS  Google Scholar 

  65. Greenwood-Van Meerveld B, et al. Attenuation by spinal cord stimulation of a nociceptive reflex generated by colorectal distention in a rat model. Auton Neurosci. 2003;104(1):17–24.

    Article  PubMed  Google Scholar 

  66. Linderoth B, Foreman R. Physiology of spinal cord stimulation: review and update. Neuromodulation. 1999;2:150–64.

    Article  PubMed  CAS  Google Scholar 

  67. Qin C, et al. Spinal cord stimulation modulates intraspinal colorectal visceroreceptive transmission in rats. Neurosci Res. 2007;58(1):58–66.

    Article  PubMed  CAS  Google Scholar 

  68. Ceballos A, et al. Spinal cord stimulation: a possible therapeutic alternative for chronic mesenteric ischaemia. Pain. 2000;87(1):99–101.

    Article  PubMed  CAS  Google Scholar 

  69. Jackson M, Simpson KH. Spinal cord stimulation in a patient with persistent oesophageal pain. Pain. 2004;112(3):406–8.

    Article  PubMed  Google Scholar 

  70. Tiede JM, et al. The use of spinal cord stimulation in refractory abdominal visceral pain: case reports and literature review. Pain Pract. 2006;6(3):197–202.

    Article  PubMed  Google Scholar 

  71. Krames ES, Mousad DG. Spinal cord stimulation reverses pain and diarrheal episodes of irritable bowel syndrome: a case report. Neuromodulation. 2005;8:82–8.

    Google Scholar 

  72. Kapural L, Sessler D, Tluczek H, Nagem H. Spinal cord stimulation for visceral abdominal pain. Pain Med. 2010;11(3):347–55.

    Article  PubMed  Google Scholar 

  73. Kapural L, Rakic M. Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis: a case report. Clin Gastroenterol Hepatol. 2008;42(6):750–1.

    Google Scholar 

  74. Khan Y, Raza S, Khan E. Application of spinal cord stimulation for the treatment of abdominal visceral pain syndromes: case reports. Neuromodulation. 2005;8:14–27.

    Article  PubMed  Google Scholar 

  75. Kim JK, et al. Spinal cord stimulation for intractable visceral pain due to chronic pancreatitis. J Korean Neurosurg Soc. 2009;46(2):165–7.

    Article  PubMed  Google Scholar 

  76. Kapur S, Mutagi H, Raphael J. Spinal cord stimulation for relief of abdominal pain in two patients with familial Mediterranean fever. Br J Anaesth. 2006;97(6):866–8.

    Article  PubMed  CAS  Google Scholar 

  77. Kapural L, Deer T, Yakovlev A, Bensitel T, Hayek S, Pyles S, Narouze S, Khan Y, Kapural A, Cooper D, Stearns L, Zovkic P. Spinal cord stimulation for visceral abdominal pain: results of the national survey. Pain Med. 2010;11(5):685–91.

    Article  PubMed  Google Scholar 

  78. Kapural L, Cywinski J, Sparks D. Spinal cord stimulation for visceral pain from chronic pancreatitis. Neuromodulation. 2011;14(5):423–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Carolinas Pain Institute, Center for Clinical Research, Wake Forest Baptist Medical Center, 145 Kimel Park Drive, Winston Salem, NC, 27103, USA

    Leonardo Kapural M.D., Ph.D. & Marc D. Yelle M.D., Ph.D.

  2. Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA

    Marc D. Yelle M.D., Ph.D.

Authors
  1. Leonardo Kapural M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc D. Yelle M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leonardo Kapural M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. The Center for Pain Relief, Inc., West Virginia University, 400 Court Street, Suite 100, Charleston, 25301, West Virginia, USA

    Timothy R. Deer

  2. Stanford Pain Management Center, Redwood City, CA, Clinic Chief, Stanford University School of Medicine, Stanford, 94065, California, USA

    Michael S. Leong

  3. Department of Anesthesiology, Rush Medical College, Professor, Rush University Medical Center, Chicago, 60612, Illinois, USA

    Asokumar Buvanendran

  4. Pennsylvania State University, College of Medicine, Department of Anesthesiology, Milton S. Hershey Medical Center, Hershey, 17033-0850, Pennsylvania, USA

    Vitaly Gordin

  5. Center for Interventional Pain and Spine, Newark, DE USA, Medical Director, Bryn Mawr Hospital, Bryn Mawr, 19010, Pennsylvania, USA

    Philip S. Kim

  6. President, National Institute of Pain, Tampa, 33558, Florida, USA

    Sunil J. Panchal

  7. The LITE Center, Clinical Associate Professor, Medical Director, School of Medicine, Miami, 33143, Florida, USA

    Albert L. Ray

Rights and permissions

Reprints and permissions

Copyright information

© 2013 American Academy of Pain Medicine

About this chapter

Cite this chapter

Kapural, L., Yelle, M.D. (2013). Clinical Applications of Neuromodulation: Spinal Cord Stimulation for Abdominal Pain. In: Deer, T., et al. Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1560-2_65

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-1560-2_65

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-1559-6

  • Online ISBN: 978-1-4614-1560-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation