Association between spinal cord stimulation and top-down nociceptive inhibition in people with failed back surgery syndrome

A cohort study

Lisa Goudman, Raf Brouns, Sander De Groote, Mats De Jaeger, E. Huysmans, Patrice Forget, Maarten Moens (Corresponding Author)

Research output: Contribution to journalArticle

Abstract

Background
Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures.

Objective
To the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM.

Design
This was a prospective cohort study in people with FBSS.

Methods
Seventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus.

Results
Before SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment.

Limitations
Limitations were the small sample size and the subjective outcome parameters in the CPM model.

Conclusions
This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.
Original languageEnglish
Pages (from-to)915-923
Number of pages9
JournalPhysical Therapy
Volume99
Issue number7
Early online date27 Mar 2019
DOIs
Publication statusPublished - Jul 2019

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Failed Back Surgery Syndrome
Spinal Cord Stimulation
Cohort Studies
Pain
Inhibition (Psychology)
Periaqueductal Gray
Sural Nerve
Chronic Pain
Sample Size
Electric Stimulation
Prospective Studies

Cite this

Association between spinal cord stimulation and top-down nociceptive inhibition in people with failed back surgery syndrome : A cohort study. / Goudman, Lisa; Brouns, Raf; De Groote, Sander; De Jaeger, Mats; Huysmans, E.; Forget, Patrice; Moens, Maarten (Corresponding Author).

In: Physical Therapy, Vol. 99, No. 7, 07.2019, p. 915-923.

Research output: Contribution to journalArticle

Goudman, Lisa ; Brouns, Raf ; De Groote, Sander ; De Jaeger, Mats ; Huysmans, E. ; Forget, Patrice ; Moens, Maarten. / Association between spinal cord stimulation and top-down nociceptive inhibition in people with failed back surgery syndrome : A cohort study. In: Physical Therapy. 2019 ; Vol. 99, No. 7. pp. 915-923.
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AU - Goudman, Lisa

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AU - De Groote, Sander

AU - De Jaeger, Mats

AU - Huysmans, E.

AU - Forget, Patrice

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N2 - BackgroundDescending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures.ObjectiveTo the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM.DesignThis was a prospective cohort study in people with FBSS.MethodsSeventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus.ResultsBefore SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment.LimitationsLimitations were the small sample size and the subjective outcome parameters in the CPM model.ConclusionsThis study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.

AB - BackgroundDescending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures.ObjectiveTo the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM.DesignThis was a prospective cohort study in people with FBSS.MethodsSeventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus.ResultsBefore SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment.LimitationsLimitations were the small sample size and the subjective outcome parameters in the CPM model.ConclusionsThis study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.

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