Mechanism Of Action

The gate control theory4 was originally thought to be the major mechanism of pain relief afforded by spinal cord dorsal column stimulation. Thus, large afferent fibers were thought to functionally close the gate to small diameter myelinated and unmyelinated fiber pain input. The gate control theory is probably inadequate to explain the mechanism of action of spinal stimulation as a sole theory. Experimental evidence suggests that altered neu-rochemical transmitter pools, conduction block of ascending pain transmission, activation of descending pain inhibiting neural tracts, supraspinal gating activity, and potentially other mechanisms are operative as well (Figure 20.1 ).5

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