Alpha Oscillations and Conditioned Pain Modulation Is Associated With Treatment Resistance to Spinal Cord Stimulation...

Area of Science:

• Neuroscience
• Pain Research
• Medical Imaging

Background:

• Neuropathic pain (NP) significantly reduces quality of life.
• Spinal cord stimulation (SCS) offers pain relief but is not universally effective.
• Predictive markers for SCS treatment response are crucial for personalized pain management.

Purpose of the Study:

• To investigate if pre-treatment resting-state magnetoencephalography (MEG) alpha oscillations and conditioned pain modulation (CPM) can predict SCS treatment outcomes in NP patients.
• To identify potential biomarkers for identifying individuals likely to benefit from SCS.

Main Methods:

• Forty NP patients underwent pre-SCS evaluation including pain self-reports, CPM, MRI, and MEG scans.
• MEG was used to analyze alpha oscillations (8-13 Hz) within the dynamic pain connectome.
• Treatment responders were defined as those achieving ≥30% pain reduction after a 12-day SCS trial.

Main Results:

• Half of the NP patients responded to SCS, showing significant pain reduction and improved quality of life.
• Lower alpha power in the salience network and nociceptive pathway predicted SCS pain relief, with sex-specific regional trends.
• Non-responders exhibited inefficient CPM and reduced peak alpha frequency in the subgenual anterior cingulate cortex.

Conclusions:

• Abnormalities in alpha oscillations and CPM are associated with ineffective SCS treatment for NP.
• These brain-behavioral features hold potential as predictive markers for personalized SCS therapy.
• Findings advance understanding of NP variability and suggest neural targets for SCS-resistant pain.