Cortical evoked responses to evaluate the effect of spinal cord stimulation on the pain pathways

IF 2 Q3 NEUROSCIENCES

Clinical Neurophysiology Practice Pub Date : 2025-01-01 DOI:10.1016/j.cnp.2025.04.003

Laurien J. Reinders, Cecile C. de Vos

{"title":"Cortical evoked responses to evaluate the effect of spinal cord stimulation on the pain pathways","authors":"Laurien J. Reinders, Cecile C. de Vos","doi":"10.1016/j.cnp.2025.04.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>The mechanisms of spinal cord stimulation (SCS) are insufficiently understood. Conditioned pain modulation (CPM) measures how a painful stimulus is affected by a second painful stimulus. We investigated whether cortical evoked response can be used to evaluate CPM in a patient treated with burst, tonic and sham SCS.</div></div><div><h3>Methods</h3><div>A 40-year-old patient underwent 3 magnetoencephalography sessions (burst, tonic, sham SCS) with 1-week intervals. Painful electrical stimuli were applied to the tibial nerve before, during and after CPM (conditioning: icepack on forearm). Evoked responses were analysed in the primary somatosensory and anterior cingulate cortices.</div></div><div><h3>Results</h3><div>Before CPM, the highest evoked response amplitude occurred under sham SCS, followed by tonic SCS. During CPM pain ratings remained unchanged. However, CPM reduced evoked response amplitudes in the primary somatosensory cortex under tonic and sham SCS and in the anterior cingulate cortex under all SCS paradigms.</div></div><div><h3>Conclusions</h3><div>CPM reduced evoked response amplitudes, while pain ratings were unaffected, suggesting neurophysiological measures provide additional insights into CPM effects. Tonic and burst SCS both appeared to reduce cortical capacity to attend to stimuli, with burst showing the greatest effect.</div></div><div><h3>Significance</h3><div>Cortical responses offer a valuable tool to assess pain pathways. Larger scale studies are needed to enhance our understanding of SCS mechanisms.</div></div>","PeriodicalId":45697,"journal":{"name":"Clinical Neurophysiology Practice","volume":"10 ","pages":"Pages 167-171"},"PeriodicalIF":2.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurophysiology Practice","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2467981X25000204","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

The mechanisms of spinal cord stimulation (SCS) are insufficiently understood. Conditioned pain modulation (CPM) measures how a painful stimulus is affected by a second painful stimulus. We investigated whether cortical evoked response can be used to evaluate CPM in a patient treated with burst, tonic and sham SCS.

Methods

A 40-year-old patient underwent 3 magnetoencephalography sessions (burst, tonic, sham SCS) with 1-week intervals. Painful electrical stimuli were applied to the tibial nerve before, during and after CPM (conditioning: icepack on forearm). Evoked responses were analysed in the primary somatosensory and anterior cingulate cortices.

Results

Before CPM, the highest evoked response amplitude occurred under sham SCS, followed by tonic SCS. During CPM pain ratings remained unchanged. However, CPM reduced evoked response amplitudes in the primary somatosensory cortex under tonic and sham SCS and in the anterior cingulate cortex under all SCS paradigms.

Conclusions

CPM reduced evoked response amplitudes, while pain ratings were unaffected, suggesting neurophysiological measures provide additional insights into CPM effects. Tonic and burst SCS both appeared to reduce cortical capacity to attend to stimuli, with burst showing the greatest effect.

Significance

Cortical responses offer a valuable tool to assess pain pathways. Larger scale studies are needed to enhance our understanding of SCS mechanisms.

查看原文本刊更多论文

皮质诱发反应评价脊髓刺激对疼痛通路的影响

目的脊髓刺激（SCS）的机制尚不清楚。条件疼痛调节（CPM）测量一个疼痛刺激如何受到第二个疼痛刺激的影响。我们研究了皮质诱发反应是否可以用来评估经破裂、强直和假性SCS治疗的患者的CPM。方法40岁患者每隔1周进行3次脑磁图检查（burst、tonic、sham SCS）。在CPM之前、期间和之后分别对胫骨神经施加疼痛性电刺激（调节：前臂冰袋）。分析了初级体感皮层和前扣带皮层的诱发反应。结果CPM前，假性SCS诱发反应幅度最大，紧张性SCS次之。在CPM期间，疼痛评分保持不变。然而，CPM降低了强直性和假性SCS下初级体感觉皮层以及所有SCS模式下前扣带皮层的诱发反应振幅。结论scpm降低了诱发反应幅度，而疼痛评分未受影响，提示神经生理学测量为CPM的作用提供了额外的见解。强直性和突发性SCS均表现出降低皮层对刺激的响应能力，其中突发性表现出最大的影响。皮层反应为评估疼痛通路提供了一个有价值的工具。需要更大规模的研究来加强我们对SCS机制的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Neurophysiology Practice NEUROSCIENCES-

CiteScore

3.90

自引率

0.00%

发文量

审稿时长

71 days

期刊介绍： Clinical Neurophysiology Practice (CNP) is a new Open Access journal that focuses on clinical practice issues in clinical neurophysiology including relevant new research, case reports or clinical series, normal values and didactic reviews. It is an official journal of the International Federation of Clinical Neurophysiology and complements Clinical Neurophysiology which focuses on innovative research in the specialty. It has a role in supporting established clinical practice, and an educational role for trainees, technicians and practitioners.