Spinal cord stimulation attenuates temporal summation in patients with neuropathic pain

Eisenberg, Elon; Burstein, Yulia; Suzan, Erica; Treister, Roi; Aviram, Joshua

doi:10.1097/01.j.pain.0000460342.69718.a2

Cited by 42 publications

(50 citation statements)

References 20 publications

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“…Individuals differ broadly in their degree of temporal summation, and many groups of patients with persistent pain exhibit increased temporal summation relative to controls [268]. Temporal summation of pain can be reduced by a variety of analgesic treatments, from ketamine [3] to spinal cord stimulation [87] to acupuncture [271] to exercise [235]. Recent studies of post-operative pain have highlighted the potential prognostic value of temporal summation for predicting the development of persistent post-operative pain [189] and for profiling patients with various chronic pain syndromes including osteoarthritis and atypical odontalgia [86;197].…”

Section: Phenotypic Domainsmentioning

confidence: 99%

Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations

Edwards

Dworkin

Turk

et al. 2016

Pain

298

261

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There is tremendous inter-patient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for “precision medicine”, or personalized pain therapeutics (i.e., empirically-based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain, and the success rates for putative analgesic drugs in Phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain.

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Section: Phenotypic Domainsmentioning

confidence: 99%

Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations

Edwards

Dworkin

Turk

et al. 2016

Pain

298

261

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show abstract

“…We need more studies like the one by Eisenberg et al 4 on the relation between SCS and endogenous pain modulation to increase our understanding of the specific conditions in which this approach will work and to develop better patient selection criteria based on simple and accurate clinical testing.…”

Section: Importance Of Higher Center Effects Of Spinal Cord Stimulationmentioning

confidence: 98%

“…4 Their project aimed at measuring the effect of SCS on central sensitization by measuring TS in patients with neuropathy using SCS for their chronic pain condition. Their hypothesis is derived from animal models that demonstrate that SCS was effective in reducing wide-dynamic-range neurons' activity that is known to be implicated in central sensitization of neuropathic pain.…”

mentioning

confidence: 99%

Spinal cord stimulation analgesia

Marchand

2015

Pain

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T he use of neuromodulation by electrical stimulation of the peripheral or central nervous system for the treatment of pain has been around for a long time, beginning with the use of electric eels thousands of years ago. 7 Our modern understanding of the mechanisms of electrical stimulation for pain relief comes from the gate control theory, according to which the selective stimulation of nonnociceptive afferents (Ab) inhibits nociceptive afferents (A∂ and C) by the activation of inhibitory interneurons in the substantia gelatinosa of the posterior horns of the spinal cord. 10 Transcutaneous electrical nerve stimulation (TENS) was developed to trigger this endogenous analgesia by peripheral stimulation. The development of spinal cord stimulation (SCS) derives from the same basic mechanisms, but with a central stimulator. 13 Spinal cord stimulation consists of implantation of periepidural electrode in the posterior columns of the spinal cord at the spinal level of the dermatomes on which we want to produce the analgesic effect. The mechanism of function of SCS is based on the same neurophysiological postulate as TENS. However, unlike TENS, the fact that the stimulation is applied directly to the posterior horns of the spinal cord does not allow us to conclude on the specific neurophysiological mechanisms of this analgesia. The stimulation may recruit afferents from the periphery, afferents from the spinal cord to the higher centers, local neuron circuits, and even fibers of the anterior horns of the spinal cord. 6 Spinal cord stimulations have been used for different types of pain with moderate success; a little more than 50% of the patients achieve pain relief of approximately 50%. 16 We have to place these results in the context that SCS is commonly an end-of-the-road approach where conventional treatments have failed. It is suggested that patient selection is one of the burdens of SCS success. Most of the patient selection criteria are designed around exclusion criteria such as psychological problems, or inclusion criteria such as SCS trials with externalized electrodes to test for a good paresthesia and pain relief before the implant. 16,17 However, even when controlling for several factors such as pain location, history of surgery, initial level of pain, litigation/worker's compensation, age, gender, duration of pain, duration of follow-up, publication year, continent of data collection, study design, quality score, method of SCS lead implant, and type of SCS lead, the outcomes are still around 50% pain relief for 50% of the patients. 16 Probably the most important factor in predicting the efficacy of SCS and in selecting patients who are the best responders is to try to establish a relation between the mechanisms of SCS analgesia and identification of the neurophysiological mechanisms implicated in a specific chronic pain condition. For instance, the use of spinal (nociceptive reflexes-RIII) and cortical activity (somatosensory-evoked potentials [SEP]) permitted investigators to demonstrate that reduced RIII...

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“…Windup in WDR neurons is a short-term, activity-dependent neuronal sensitization that involves temporal summation of nociceptive inputs mediated by C-fibers on postsynaptic neurons. Intriguingly, inhibition of the temporal summation of pain during a trial of traditional SCS has been suggested to help in selection of patients for this treatment and in prediction of who will respond to its long-term efficacy [47]. Furthermore, activation of dorsal columns with traditional SCS parameters blocks windup [26, 42, 50].…”

Section: Comparison Of Mechanisms For Pain Inhibition By Paresthesia-mentioning

confidence: 99%

“…In addition, the hyper-excitability in dorsal horn neurons after nerve injury can be normalized by traditional SCS [26, 41, 42]. Thus, tempering the spinal neuronal sensitization may contribute to traditional SCS-induced pain inhibition [26, 42, 47–50]. However, this mode of action remains to be demonstrated for paresthesia-free HF-SCS.…”

Section: Comparison Of Mechanisms For Pain Inhibition By Paresthesia-mentioning

confidence: 99%

Spinal Cord Stimulation for Treating Chronic Pain: Reviewing Preclinical and Clinical Data on Paresthesia-Free High-Frequency Therapy

Chakravarthy

Richter

Christo

et al. 2018

Neuromodulation: Technology at the Neural Interface

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To fully understand and utilize paresthesia-free HF-SCS, mechanistic study and translational research will be very important, with increasing collaboration between basic science and clinical communities to design better trials and optimize the therapy based on mechanistic findings from effective preclinical models and approaches. Future research in these vital areas may include preclinical and clinical components conducted in parallel to optimize the potential of this technology.

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Spinal cord stimulation attenuates temporal summation in patients with neuropathic pain

Cited by 42 publications

References 20 publications

Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations

Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations

Spinal cord stimulation analgesia

Spinal Cord Stimulation for Treating Chronic Pain: Reviewing Preclinical and Clinical Data on Paresthesia-Free High-Frequency Therapy

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