Evidence map›Paper›PMID 30407696›Full record

ReviewEuropean journal of pain (London, England)2019

Mechanisms of spinal cord stimulation for the treatment of pain: Still in the dark after 50 years.

Melanie P Jensen, Robert M Brownstone

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in European journal of pain (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Implanted spinal neuromodulation interventions for chronic pain in adults.The Cochrane database of systematic reviews · 2021
    Pooled it
  3. Pooled it
  4. Trial
  5. Article
  6. Article
  7. Article
  8. Article
  9. Observational
  10. Computational Optimization of Spinal Cord Stimulation for Dorsal Horn Interneuron Polarization.Neuromodulation : journal of the International Neuromodulation Society · 2025
    Article
  11. Article
  12. Activity of spinal RORβ neurons is related to functional improvements following combination treatment after complete SCI.Proceedings of the National Academy of Sciences of the United States of America · 2025
    Article
  13. Article
  14. Article
  15. Review
  16. Review
  17. Review
  18. Article
  19. Article
  20. Review

4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Melanie P JensenSobell Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.
Robert M BrownstoneSobell Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, UK.

Funding

Wellcome Trust 110193Wellcome Trust 110193/Z/15/Z
6 · The paper itself

Abstract

BACKGROUND AND

objectiveDespite the value of spinal cord stimulation (SCS) in treating some patients with focal neuropathic pain, technological advances in stimulator design and treatment protocols have not correlated with significant improvements in clinical outcomes. This may be because incomplete understanding of the mechanisms underlying SCS precludes improvement in clinical efficacy. In this brief review, we (a) review phenomenological effects of SCS, (b) review the literature on proposed spinal sites of action of SCS and (c) propose a novel hypothesis of mechanism of action.

resultsDorsal columns, dorsal roots and dorsal horns have each been proposed as spinal sites of action of SCS. We suggest that evidence in favour of the dorsal columns or dorsal roots as the primary mediators of SCS is weak and propose that the dorsal horn is the crucial site of action. Furthermore, we hypothesize that, based on their location, and neurochemical and morphological properties, dorsal horn islet cells may mediate the effects of SCS.

conclusionsThe precise spinal mechanisms of action of SCS are still unknown. Dorsal horn islet cells have properties that position them to play a key role in analgesic effects of electrical stimulation. Understanding the mechanisms responsible for positive SCS effects are needed for successful translation into clinical dividends. SIGNIFICANCE: We review possible spinal mechanisms of action of spinal cord stimulation for neuropathic pain, proposing that direct modulation of dorsal horn neurons is crucial. We suggest that mechanistic insights are needed for translation into more favourable clinical outcomes.

Indexed as

Posterior Horn CellsSpinal Cord Dorsal HornSpinal Nerve RootsAnimalsHumansNeuralgiaPain ManagementSpinal CordSpinal Cord Stimulation

Identifiers

PMID30407696
PMCPMC6491991

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.