Spinal Cord Stimulation in Patients With Complex Regional Pain Syndrome: A Possible Target for Immunomodulation?

Selective L4 Dorsal Root Ganglion Stimulation Evokes Pain Relief and Changes of Inflammatory Markers: Part I Profiling of Saliva and Serum Molecular Patterns

“…In line with previous tonic SCS and DRG‐SCS human studies (uncontrolled), serum levels of pro‐inflammatory mediators such as IL‐1β, TNF‐α, and IL‐6 were significantly increased compared to healthy individuals within the entire study period. For instance, an elevated CSF level of BDNF was demonstrated in FBSS patients with predominant neuropathic leg pain under tonic SCS compared to healthy controls . BDNF, another inflammatory marker of neuropathic pain and depression, was higher in our chronic neuropathic pain cohort, but remained unchanged after L4‐DRG STIM .…”

“…Extracellular HMGB‐1 exposition activates macrophages/monocytes host response in the early phase of inflammation. To the best of our knowledge, this is the first study demonstrating increased serum levels of HMGB‐1 in CRPS patients treated with L4‐DRG stimulation .…”

“…Several mechanisms (alteration of the membrane function [ion influx] or increased peptide expression leading to hyperexcitability in DRG and spinal cord neurons) may contribute to the maintenance or transition from acute to chronic neuropathic pain. Most of the uncontrolled observational human studies related to spinal neuromodulation and inflammation examined the effects of either tonic, or BurstDR SCS waveform on nociceptive back pain or neuropathic pain of the extremities as primary pain indication (41,42). The antinoceptive potential of oxytocin has been welldocumented (17)(18)(19)(20)(21)(22)(23)(24).…”

“…In addition, preclinical findings indicate a pro-inflammatory state mediated by cytokines/chemokines in chronic neuropathic and nociceptive pain syndromes (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Preliminary open-label human pilot studies observed that the tonic and BurstDR SCS substantially impact CSF and serum concentrations of pro-and anti-inflammatory biomarker pattern in both subtypes of chronic pain (41,42).…”

Objective Measures to Characterize the Physiological Effects of Spinal Cord Stimulation in Neuropathic Pain: A Literature Review

“…Three studies quantified changes in the blood plasma/serum of neuropathic pain patients, before and after SCS, to identify potential molecular and/or cellular biomarkers of SCS . Based on the recently‐proposed theory that chronic pain could be a consequence of a neuroinflammatory process , a study by Kinfe et al examined the association of SCS on pro‐ and anti‐inflammatory cytokines.…”