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History of Peripheral Nerve Stimulation for Pain
Introduction
For more than 5000 years, electrical stimulation has been used to treat pain, among other medical conditions. The King Narmer papyrus from 3100 BC describes the use of the Nile catfish, which has a bioelectric generator, for pain control, and Scribonius Largus reported using the torpedo fish in the first century AD. Methods of generating electricity artificially were developed in the 17th and 18th centuries, and among the earliest applications were medical treatment, particularly for pain, by well-known historical figures such as Volta, Galvani, Franklin, Faraday, Sherrington, and others. In the late 19th and early 20th centuries, a variety of electrical stimulation devices were developed and marketed for the treatment of pain, and some (e.g., the Electreat) achieved widespread use and commercial success.
The Gate-Control Theory
Publication of the “gate theory” by Ronald Melzack and Patrick Wall in 1965 ushered in the modern era of electrical stimulation for pain relief. The theory held that the balance of afferent activity between large and small fibers in the peripheral nervous system determines whether a pain signal is propagated centrally. An excess of large-fiber activity will close, while an excess of small-fiber activity will open, the “gate” in the dorsal horn of the spinal cord. It happens that large fibers in a mixed peripheral nerve can be recruited by an externally applied electrical field at a lower threshold than small fibers, and the theory predicts that this will close the “gate” and relieve pain.
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