History of Neurostimulation

Chapter Overview

Chapter Synopsis: The history of neurostimulation for pain relief reaches back nearly 2000 years to Greece. As with many ancient remedies, healers made use of the natural physiology of an animal—in this case the electrical discharge from a torpedo fish. Since then electrical stimulation devices have come a long way, as has our understanding of the underlying mechanisms. History shows that physicians in Europe and the United States shepherded this development through the 18th and 19th centuries. Even Ben Franklin made a well intended although ill-fated foray into medical research with electrostimulation. The popularity of neurostimulation in the early 20th century seemed to reach its culmination with the advent of a colorfully named and widely used device called the Electreat, an early version of today’s more sophisticated transcutaneous electrical nerve stimulation (TENS) devices. With the establishment of Melzack and Wall’s gate control theory of pain in the 1960s, clinical neurostimulation underwent a more informed evolution. Norman Shealy’s contributions led to both scientific and technological advances. Eventually experiments revealed the efficacy of deep brain stimulation for relief of central pain and other conditions. Although an ancient practice, the benefits of neurostimulation have likely not yet been entirely revealed or appreciated.

Important Points:

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The first documented use of neurostimulation for pain relief occurred around 63 ad .
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The Leyden jar was one of the first methods of harnessing electrical current.
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The Melzack-Wall gate control theory was a defining event in the use of neurostimulation in modern medicine.
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Medtronic received Food and Drug Administration approval in the late 1960s to distribute devices for the treatment of pain.
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Ballard D. Wright described the use of the block-aid monitor in 1969 for nerve stimulation.
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In 1991 Tsubokawa made key advances in motor cortex stimulation for central pain control.

Early Discoveries

The first documented use of neurostimulation for pain relief occurred in Greece around 63 ad . It was reported by Scribonius Largus that pain from gout was largely relieved by standing on a torpedo fish ( Fig. 1-1 ), and recommended this treatment for pain in general. He said,

“For any type of gout, a live black torpedo should, when the pain begins, be placed under the feet. The patient must stand on a moist shore washed by the sea, and he should stay like this until the whole foot and leg up to the knee is numb. This takes away present pain and prevents pain from coming on if it has not already arisen. In this way Ateros, a freedman of Tiberius, was cured.”

In 1771 Luigi Galvani, an Italian physician and physicist, discovered that the leg muscles of a frog twitched when electricity was applied, thereby effectively debuting the study of bioelectricity. Gilbert, a famous 17th century scientist, described the relationship of electromagnetism to pain symptom management on his discovery that a piece of magnetic iron ore could be used in the treatment of headaches, mental disorders, and marital infidelity.

In the years following Gilbert’s work, a method of harnessing electrical current was invented that would allow for the development of modern therapies. This device was called the Leyden jar ( Fig. 1-2 ). This device was constructed by placing water in a metal container and placing brass wire through a cork top into the water. In 1746, using a Leyden jar, Jean Jallabert discovered the ability to use electricity to stimulate muscle fibers. Jallabert treated a paralyzed limb by causing involuntary contractions leading to regeneration of muscle and increased blood flow. This success led many others in the field to pursue similar methods of treatment.