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Acta Neurochirurgica

, Volume 160, Issue 12, pp 2509–2519 | Cite as

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

  • Sigrid Schuh-Hofer
  • Janina Fischer
  • Andreas Unterberg
  • Rolf-Detlef Treede
  • Rezvan Ahmadi
Original Article - Functional Neurosurgery - Pain
  • 172 Downloads
Part of the following topical collections:
  1. Functional Neurosurgery – Pain

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.

Keywords

Spinal cord stimulation Descending pain modulation Quantitative sensory testing Cold pressor test Neuropathic pain 

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

Notes

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).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

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

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Sigrid Schuh-Hofer
    • 1
  • Janina Fischer
    • 2
  • Andreas Unterberg
    • 2
  • Rolf-Detlef Treede
    • 1
  • Rezvan Ahmadi
    • 2
  1. 1.Department of Neurophysiology, Centre for Biomedicine and Medical Technology MannheimHeidelberg UniversityMannheimGermany
  2. 2.Department of NeurosurgeryUniversity Hospital HeidelbergHeidelbergGermany

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