Quantitative Evaluation of Tonic Spinal Cord Stimulation in Treating Chemotherapy-Induced Peripheral Neuropathy: A Single-Center Prospective Cohort Exploratory Pilot Study.

Abstract

Objectives: Chemotherapy-induced peripheral neuropathy (CIPN), a prevalent and debilitating side effect of neurotoxic agents, affects a significant proportion of patients with cancer during and after treatment. Spinal cord stimulation (SCS) has shown limited efficacy in relieving the symptoms of chronic neuropathic pain. In this prospective, single-center pilot study, nine patients with lower-extremity CIPN underwent tonic SCS implantation.

Materials and methods: Treatment-Induced Neuropathy Assessment Scale (TNAS) scores, Patient-Reported Outcomes Measurement Information System (PROMIS)-29 + 2 Profile v2.1 (PROPr) patient-reported outcomes (PROs), gait assessments, and quantitative sensory tests (QSTs) were administered at baseline and at 30 days, 90 days, six months, and 12 months after SCS. Statistical analyses included repeated measures analysis of variance or paired t-tests for normally distributed data, Friedman and Wilcoxon signed-rank tests for nonparametric data, and Pearson correlations among TNAS domains, QST measures, and gait velocity.

Results: At 30 days after SCS, patients indicated significant improvements across all TNAS domains and PROMIS-29 outcomes of pain interference, physical functioning, and pain intensity (all p < 0.01). Gait analysis revealed improved velocity (p = 0.002) and ambulation time (p = 0.014). QSTs showed significantly decreased (improved) touch thresholds and sharp thresholds at 30 days at subtalus (all p < 0.05). Greater CIPN symptom severity, as measured by TNAS numbness, tingling, pain, and walking difficulty scores, was significantly associated with slower gait velocity (ρ = -0.60 to -0.52, all p < 0.001). In addition, higher touch- and sharp-detection thresholds were strongly correlated with higher TNAS scores (all p < 0.01).

Conclusions: Our preliminary findings highlight the potential therapeutic effects of SCS on alleviating CIPN-related pain and neuropathy and support the use of psychophysical testing to monitor disease progression and/or improvement after intervention. However, future studies with larger and more diverse patient populations are needed to validate the use of SCS and gait analysis in clinical practice.