New paradigms and Understanding of how Spinal Cord Stimulation can improve psychological Disorders on the long Term

by
Dany Ghassan Charbel, Msc
Robert W. D. Gorter, MD, PhD.

10th January,2024

Scientists investigate the origins of the human spine

Spinal cord:

What is the spinal cord?

The spinal cord is a long bundle of nerves and cells that extends from the lower portion of the brain to the lower back. Spinal cord functions include carrying signals between the brain and the rest of the body.

One of the primary responsibilities of the spinal cord is to carry signals from the brain to different parts of the body. It does this through the nerves that connect your brain to other specific body parts. These nerve signals have three main roles.

  1. Regulate body movements
  2. Send sensory signals.
  3. Control your reflexes.

Anatomy of the spine

The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain.

Spinal curves

When viewed from the side, an adult spine has a natural S-shaped curve. The neck (cervical) and low back (lumbar) regions have a slight concave curve, and the thoracic and sacral regions have a gentle convex curve (Fig. 1). The curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion throughout the spinal column.

Illustration, sideview, standing human skeleton with cervical, thoracic, lumbar curves highlighted
Figure 1. The spine has three natural curves that form an S-shape; strong muscles keep our spine in alignment.
Illustration, sideview, head & torso, with vertebrae and 5 regions of spine labeled
Figure 2. The five regions of the spinal column.

The abdominal and back muscles maintain the spine’s natural curves. Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on the spine during movement or weight-bearing activities (see Posture). Excess body weight, weak muscles, and other forces can pull at the spine’s alignment:

  • An abnormal curve of the lumbar spine is lordosis, also called sway back.
  • An abnormal curve of the thoracic spine is kyphosis, also called hunchback.
  • An abnormal curve from side-to-side is called scoliosis.

What are the differences between motor and sensory nerves in the spinal cord?

Motor neurons have a cell body, short dendrites and a long axon. Their function is to conduct impulses to an effector (muscle or gland). Sensory neurons, on the other hand, have a cell body, long dendrites and a short axon. Their function is to conduct impulses to the Central Nervous System.

What can the spinal cord control?

Motor Functions – directs your body’s voluntary muscle movements. Sensory Functions – monitors sensation of touch, pressure, temperature and pain. Autonomic Functions – regulates digestion, urination, body temperature, heart rate, respiration and dilation/contraction of blood vessels (blood pressure).

What is spinal cord stimulation SCS?

Spinal cord stimulation, or SCS, is a medical treatment that involves the use of electrical signals to block pain nerves of the spine to greatly reduce the sensation of pain. This kind of treatment is usually used in cases where other treatments like medicine, exercise, and/or injections have not been successful.

Spinal Stimulation shows Promise as Depression Treatment

Researchers conducted a pilot clinical trial showing that spinal cord stimulation (SCS) is a feasible and well-tolerated method with potential to treat major depressive disorder. The trial involved 20 patients undergoing three weekly 20-minute SCS sessions over eight weeks.

Results revealed that those who received active stimulation exhibited a greater decrease in depressive symptom severity compared to the control group. This innovative approach suggests that modulating brain-body neural pathways through SCS can significantly impact mood regulation and offers a novel direction in treating psychiatric disorders.

Key Facts:

  1. The study showed spinal cord stimulation to be a promising treatment for depression, well-tolerated by patients.
  2. Participants receiving active stimulation experienced a significant reduction in depressive symptoms.
  3. The research opens possibilities for further trials and development of a portable SCS device for psychiatric disorder treatment.

Source: University of Cincinnati, USA.

A pilot clinical trial led by University of Cincinnati researchers at the Lindner Center of HOPE found electrical stimulation of the spinal cord is feasible, well-tolerated and shows therapeutic potential to treat depression.

The results of the trial were published in the journal Molecular Psychiatry on Dec. 20, 2023.

Principal investigator Francisco Romo-Nava, MD, PhD, said his research focuses on how brain-body communication is involved in psychiatric disorders.

The spinal cord stimulation is designed to decrease the flow of information in the brain-body circuit so that the brain is better able to readjust and regulate itself.

“Spinal cord stimulation is thought to help the brain modulate itself as it should by decreasing the noise or decreasing the hyperactive signaling that may be in place during a depressive syndrome,” Romo-Nava said.

The investigational device that was used is no larger than a shoe box, with the active electrode placed on the patient’s back and the return electrode placed on their right shoulder.

Transcutaneous electrical Nerve stimulation (TENS)

TENS is a method of electrical stimulation which primarily aims to provide a degree of symptomatic pain relief by exciting sensory nerves and thereby stimulating either the pain gate mechanism and/or the opioid system. The different methods of applying TENS relate to these different physiological mechanisms. The effectiveness of TENS varies with the clinical pain being treated, but research would suggest that when used ‘well’ it provides significantly greater pain relief than a placebo intervention. There is an extensive research base for TENS in both the clinical and laboratory settings and whilst this summary does not provide a full review of the literature, the key papers are referenced. It is worth noting that the term TENS could represent the use of ANY electrical stimulation using skin surface electrodes which has the intention of stimulating nerves.

Chakras are energy centers located along the spinal column.

The first one is located on the same level as the coccyx (tail bone) and is called the root chakra, that which connects us to the earth and anchors us in reality. The second one, called the sacral chakra, is located just below the navel. The third one, at the level of the stomach, is the solar plexus chakra. The heart chakra sits in the region of the body that carries its name, then comes the throat chakra. Then a little bit higher, the third eye chakra, just between the eyes, invites you to look inside yourself and to connect yourself to subtle energies. Lastly, the crown chakra at the top of the head connects us to the higher worlds.

https://miro.medium.com/v2/resize:fit:780/1*9n3o4VbrWmQB9dl7ELRa1w.png

Hindu and Buddhist traditions describe a series of seven chakras (from the Sanskrit for “wheel”) located along the spine, which are hubs of energy collection and distribution. So elaborate are these descriptions that they each have their own physiological significance, seed syllables, sounds, subtle elements, colors, and even deities. They are said to influence qualities as subtle as emotions and virtues.

Traditional Chinese medicine and Taoist thought have similar theories involving the flow of energy (chi) along channels and intersecting at physiological centers often associated with physical organs. While we do not pretend to completely understand these concepts, one cannot help but notice an interesting overlap both anatomically and functionally with major nerve plexuses in the body.

How close were the ancients to understanding human physiology in the depth and detail we do today?

The human body, like all vertebrates, is controlled in part by nerves which convey impulses to and from the brain via the spinal cord and nerve complexes located next to it. These concentrations of nerve bodies, or ganglia, support major physiological functions from breathing to heart rate to digestion, elimination and sex.

The vast bulk of information processing that happens just to keep us alive and functioning happens beyond our conscious awareness throughout the body. Although we are unaware of this activity, it is not true that we cannot consciously influence it. A bowel movement is controlled by autonomic processes; yet, we learn to control it early in childhood along with urination. Breathing happens without thought, yet we can consciously choose to breathe or hold the breath. Yogic traditions and tantra have elaborate systems of breathing exercises, postures and locks designed to specifically influence the chakras and flow of energy which lend themselves to interpretation through Western science and medicine.

References:

Rose, C. (2023, December20), Spinal Stimulation Shows Promise As Depression Treatment, Neuroscience. News.com.

https://www.spinalcord.com/blog/functions-of-the-spinal-cord-what-you-need-to-know.

Claydon, Leica S. BSc (Hons), PhD. The clinical journal of pain, p.635-647, September 2011.

Carol Bedwell LLB(Hons),Rn (ResearchMidwife) The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence, Science direct, volume 27, October 2011.

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