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The association between spinal cord stimulation and top-down nociceptive inhibition in failed back surgery syndrome patients
Author(s): ,
L. Goudman
Affiliations:
UZ Brussel, Jette, Belgium
,
R. Brouns
Affiliations:
ZorgSaam hospital, Terneuzen, Netherlands
,
S. De Groote
Affiliations:
UZ Brussel, Jette, Belgium
,
M. De Jaeger
Affiliations:
UZ Brussel, Jette, Belgium
,
E. Huysmans
Affiliations:
VUB, Jette, Belgium
,
P. Forget
Affiliations:
UZ Brussel, Jette, Belgium
M. Moens
Affiliations:
UZ Brussel, Jette, Belgium
EANS Academy. Goudman L. Oct 21, 2018; 225683; EP7015
Lisa Goudman
Lisa Goudman
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Abstract
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Background
The descending nociceptive inhibitory pathways often malfunction in chronic pain patients. Conditioned pain modulation (CPM) is an experimental evaluation tool to assess the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for patients with failed back surgery syndrome (FBSS), exerts its pain-relieving effect through a complex interplay of different systems among which the descending pathways. To the best of our knowledge, no clinical studies exist in which the associations between SCS and CPM have been thoroughly investigated.
Method

Seventeen patients with FBSS, scheduled for SCS, were enrolled in this study. The CPM model was evaluated at both sural nerves and was induced by electrical stimulation as test stimulus and the cold pressor test as conditioning stimulus.
Results
Before SCS, less than 30% of the patients with FBSS demonstrated a CPM effect. Significant increases in EPDT on the symptomatic side (p=0.04) and non-symptomatic side (p=0.02) were found. On the symptomatic side, no differences in the number of CPM responders before and after SCS could be found (p=0.53). On the non-symptomatic side more patients had a CPM effect during SCS (p=0.04). Additionally, there was a significant difference in CPM activation and SCS treatment.
Conclusions
This study revealed for the first time a bilateral effect of SCS which is suggestive for the involvement of higher order structures, such as the descending pathways, as previously suggested by animal research.
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