Another presentation given at the Napa Pain Conference was Dr. Elliot Krames’, Neuromodulation: The Past, The Present, and The Future. Dr. Krames is a very insightful, colorful speaker, and his career has significant history to it. He began with the question, “What is neuromodulation?” His answer: “The beauty of science.”

Dr. Krames proceeded to look at neuromodulation: the past, a little bit of history, and some new devices. He discussed Scribonius Largus, a court physician to a Roman Emperor, and one of the first to use electrical currents to produce transient pain relief using direct application of torpedo fish or eels. Dr. Krames shed light onto the work of various pioneers who used alternating current, and then fast-forwarded to the devices that modulate nerves.

Dr. Krames mentioned that the original pacemaker was first invented in the 1930s, and how in the 1950s and 60s a hospital in Minnesota started using pacemakers to help children recover from heart surgery. These devices were very crude, as they were external implantable devices. Therefore, Dr. William Chardack and engineer Wilson Greatbatch invented the first fully-implantable pacemaker.

Dr. Krames then brought an interesting theory into his discussion. To quote the doctor, “The present operating theory of pain is important for understanding the role of electrical stimulation for pain.” He called this, “The gate control theory of pain.” He continued by reviewing some early research of the gate control theory, and acknowledged the pioneers involved with it. This was a fascinating topic about which I would like to have further conversations with the doctor.

Dr. Krames then readdressed the issues of stimulation, as well as perceptions of pain, and then discussed the first spinal cord stimulator that was introduced in 1967 by Dr. Shealy, Dr. Mortimer, and Dr. Reswick. He transitioned to deep-brain stimulation, and gave a small history thereof. From here, he continued to a small, condensed history of the intrathecal therapies for pain control. I do strongly suggest that you read Dr. Krames article in the past May/June issue of Neuromodulation as it provides a great history of intrathecal therapies and intra-spinal injections of various agents for the control of pain.

Dr. Krames then posed the question, “Why was the opium poppy created for the benefit of mankind?” This led into a very interesting story of endogenous opioids that reviewed the discoveries of endorphins and enkephalins. Endorphins are endogenous opiate peptides that interact with receptors within the human body (neurotransmitters, if you will) to produce pain relief. These discoveries led to some of the early work by Dr. Tony Yaksh regarding the analgesic properties demonstrated in animals through the intrathecal delivery of morphine, and then subsequent instraspinal morphine applied to humans for the treatment of chronic pain … and the rest was history.

Dr. Krames concluded his presentation with a discussion of new technologies and devices that are used in neuromodulation, and their effects on the spinal cord, nerve roots, and the dorsal route ganglion. He presented a lot of new changes, and interesting opportunities for neuromodulation within humans. This was truly a great lecture.

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