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Spinal cord stimulation modulates descending pain inhibition and temporal summation of pricking pain in patients with neuropathic pain

  • Original Article - Functional Neurosurgery - Pain
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Abstract

Background

Spinal cord stimulation (SCS) is an established treatment option for patients with refractory chronic pain conditions. While effects of SCS on dorsal horn neuronal circuitries are intensively studied, current knowledge on the impact of SCS on descending pain pathways is scarce and relies on preclinical data. We aimed to address this topic and hypothesized a significant effect of SCS on descending pain modulation. In light of current efforts to determine the sensitivity of “static” versus “dynamic” somatosensory parameters to characterize pathophysiological pain conditions, all SCS patients were carefully investigated using both classes of somatosensory outcome parameters.

Methods

Descending pain pathways were investigated by using a “Cold Pressor Test.” This test enables to evaluate the efficacy of conditioned pain modulation (CPM) at the individual level. CPM efficacy was assessed in eight neuropathic pain patients (age 55.5 ± 10.6) during the two conditions stimulator “ON” and “OFF.” The impact of SCS on “static” and “dynamic” somatosensory parameters was explored by using a quantitative sensory testing (QST) battery.

Results

CPM efficacy on pressure pain sensitivity was nearly absent during “OFF” (− 1.2 ± 5.6% facilitation), but increased significantly to 16.3 ± 3.4% inhibition during “ON” (p = 0.03). While most “static” nociceptive QST parameters, represented by mechanical/thermal pain thresholds, exhibited only small effects of SCS (p > 0.05), the wind-up ratio was strongly reduced to within the normal range during “ON” (p = 0.04; Cohen’s d = 1.0). Dynamic mechanical allodynia was abolished in six of seven patients.

Conclusions

Our study provides first human evidence for an impact of SCS on descending pain pathways in the dorsolateral funiculus and emphasizes the significance of “dynamic” pain measures like “CPM”-efficacy and “temporal summation” to evaluate SCS treatment effects. Future prospective studies may use these measures of nociceptive processing to predict SCS therapy response.

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Abbreviations

CDT:

Cold detection threshold

CPM:

Conditioned pain modulation

CPT:

Cold pain threshold

DMA:

Dynamic mechanical allodynia

HPT:

Heat pain threshold

MDT:

Mechanical detection threshold

MPT:

Mechanical pain threshold

MPS:

Mechanical pain sensitivity

PHS:

Paradoxical heat sensations

PPT:

Pressure pain threshold

PTT:

Pain tolerance time

QST:

Quantitative sensory testing

SD:

Standard deviation

SEM:

Standard error of the mean

SCS:

Spinal cord stimulation

TS:

Temporal summation

TSL:

Thermal sensory limen

VDT:

Vibration detection threshold

WDT:

Warm detection threshold

WUR:

Wind-up ratio

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Acknowledgments

We thank Yvonne Neu for her excellent technical support.

Funding

This work was supported by the “Deutsche Forschungsgemeinschaft” (DFG), SFB 1158 (From nociception to chronic pain: Structure-function properties of neural pathways and their reorganization).

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Authors and Affiliations

  1. Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany

    Sigrid Schuh-Hofer & Rolf-Detlef Treede

  2. Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Janina Fischer, Andreas Unterberg & Rezvan Ahmadi

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  1. Sigrid Schuh-Hofer
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  2. Janina Fischer
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  4. Rolf-Detlef Treede
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Correspondence to Rezvan Ahmadi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Functional Neurosurgery-Pain

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Schuh-Hofer, S., Fischer, J., Unterberg, A. et al. Spinal cord stimulation modulates descending pain inhibition and temporal summation of pricking pain in patients with neuropathic pain. Acta Neurochir 160, 2509–2519 (2018). https://doi.org/10.1007/s00701-018-3669-7

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