Characterization of cutaneous reflexes elicited from saphenous nerve stimulation

Phantom limb pain (PLP) is a chronic neuropathic condition that affects amputees. Cutaneous reflexes (CRs), mediated by spinal interneuronal circuits, represent a potential pathway linking non-nociceptive input to nociceptive modulation that could be targeted with neuromodulatory techniques such as operant conditioning. The objective of this study was to develop and validate a novel method for eliciting CRs from proximal muscles via saphenous nerve stimulation to enable future applications in individuals with PLP. We recruited 14 healthy adults and elicited CRs in the rectus femoris muscle via transcutaneous stimulation of the saphenous nerve at multiple stimulation intensities below their pain thresholds. We evaluated the consistency and reliability of CR response latencies and magnitudes, comparing the symmetry between the bilaterally (e.g. right and left legs). We found that CRs could be reliably elicited 50-100ms post-stimulus using saphenous stimulation and that responses were reliable at stimulation intensities below pain thresholds. Furthermore, we found the CR responses were relatively symmetrical in our healthy adult population. This study is the first of its kind to show that proximal (vs distal) CRs could be consistently elicited through the saphenous nerve stimulation. These findings imply that proximal CRs may be a feasible target for neuromodulatory interventions such as operant conditioning paradigms in the future.