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@article{595b2d471c9f4b02a2d34fa7ef2ad6b9,
title = "Association Between Spinal Cord Stimulation and Top-Down Nociceptive Inhibition in People With Failed Back Surgery Syndrome: A Cohort Study",
abstract = "Background. Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a wellknown treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures. Objective. To the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM. Design. This was a prospective cohort study in people with FBSS. Methods. Seventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus. Results. Before SCS, less than 30{\%} of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment. Limitations. Limitations were the small sample size and the subjective outcome parameters in the CPM model. Conclusions. This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.",
author = "Lisa Goudman and Raf Brouns and {De Groote}, Sander and {De Jaeger}, Mats and Eva Huysmans and Patrice Forget and Maarten Moens",
year = "2019",
month = "7",
day = "1",
doi = "10.1093/ptj/pzz051",
language = "English",
volume = "99",
pages = "915--923",
journal = "Physical Therapy",
issn = "0031-9023",
publisher = "American Physical Therapy Association",
number = "7",

}

RIS

TY - JOUR

T1 - Association Between Spinal Cord Stimulation and Top-Down Nociceptive Inhibition in People With Failed Back Surgery Syndrome: A Cohort Study

AU - Goudman, Lisa

AU - Brouns, Raf

AU - De Groote, Sander

AU - De Jaeger, Mats

AU - Huysmans, Eva

AU - Forget, Patrice

AU - Moens, Maarten

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background. Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a wellknown treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures. Objective. To the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM. Design. This was a prospective cohort study in people with FBSS. Methods. Seventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus. Results. Before SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment. Limitations. Limitations were the small sample size and the subjective outcome parameters in the CPM model. Conclusions. This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.

AB - Background. Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a wellknown treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures. Objective. To the best of our knowledge, no clinical studies have thoroughly investigated the associations between SCS and CPM. Design. This was a prospective cohort study in people with FBSS. Methods. Seventeen people who had FBSS and were scheduled for SCS were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as the test stimulus and the cold pressor test as the conditioning stimulus. Results. Before SCS, less than 30% of the participants with FBSS showed a CPM effect. Significant increases in the electrical detection threshold on the symptomatic side and the nonsymptomatic side were found. On the symptomatic side, no differences in the numbers of CPM responders before and after SCS could be found. On the nonsymptomatic side, more participants showed a CPM effect during SCS. Additionally, there were significant differences for CPM activation and SCS treatment. Limitations. Limitations were the small sample size and the subjective outcome parameters in the CPM model. Conclusions. This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.

UR - http://www.scopus.com/inward/record.url?scp=85068553791&partnerID=8YFLogxK

U2 - 10.1093/ptj/pzz051

DO - 10.1093/ptj/pzz051

M3 - Article

VL - 99

SP - 915

EP - 923

JO - Physical Therapy

JF - Physical Therapy

SN - 0031-9023

IS - 7

ER -

ID: 46586941