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Effects of spinal cord stimulation on cortical excitability in patients with chronic neuropathic pain: a pilot study
Jürgen R Schlaier1, Peter Eichhammer, Berthold Langguth
1Department of Neurosurgery, University of Regensburg, 93053 Regensburg, Franz-Josef-Strauss-Allee 11, Germany. juergen.schlaier@klinik.uni-regensburg.de
Background:
Despite a broad clinical use, the mechanism of action of SCS is poorly understood. Current information suggests that the effects of SCS are mediated by a complex set of interactions at several levels of the nervous system including spinal and supraspinal mechanisms.
Aims:
The study was undertaken to investigate the influence of SCS on distinct parameters of cortical excitability using single- and paired-pulse transcranial magnetic stimulation (TMS).
Methods:
Five patients with chronic neuropathic pain were examined with the SCS stimulator on and off by means of TMS. Pain was assessed using a visual-analogue scale. Electrophysiological and pain parameters of patients during this procedure were compared by means of a linear mixed effect model.
Results:
SCS induced a significant modulation of cortical excitability, especially by influencing the parameter "intracortical facilitation" (t=-2.657; df=8; p=0.029). A significant relationship between this parameter and "perceived pain" could be obtained (t=-4.798; df=8; p=0.002).
Conclusions:
These results suggest that SCS is able to influence neurobiological processes at the supraspinal level and that clinical effects of SCS may be at least in part of cortical origin.
