Spinal cord stimulation modulates cerebral function: an fMRI study

Introduction Although spinal cord stimulation (SCS) is widely used for chronic neuropathic pain after failed spinal surgery, little is known about the underlying physiological mechanisms. This study aims to investigate the neural substrate underlying short-term (30 s) SCS by means of functional magn...

Full description

Saved in:
Bibliographic Details
Published in:Neuroradiology 2012-12, Vol.54 (12), p.1399-1407
Main Authors: Moens, M., Sunaert, S., Mariën, P., Brouns, R., De Smedt, A., Droogmans, S., Van Schuerbeek, P., Peeters, R., Poelaert, J., Nuttin, B.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analysis of Variance
Back surgery
Biological and medical sciences
Brain
Electric Stimulation Therapy - methods
Electrodiagnosis. Electric activity recording
Failed Back Surgery Syndrome - physiopathology
Failed Back Surgery Syndrome - therapy
Female
Functional Neuroradiology
Humans
Imaging
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging - methods
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Nervous system
Neuralgia - physiopathology
Neuralgia - therapy
Neurology
Neuroradiology
Neurosciences
Neurosurgery
NMR
Nuclear magnetic resonance
Pain management
Pain Measurement
Phantoms, Imaging
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Radiology
Spinal cord
Spinal Cord - physiopathology
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction Although spinal cord stimulation (SCS) is widely used for chronic neuropathic pain after failed spinal surgery, little is known about the underlying physiological mechanisms. This study aims to investigate the neural substrate underlying short-term (30 s) SCS by means of functional magnetic resonance imaging in 20 patients with failed back surgery syndrome (FBSS). Methods Twenty patients with FBSS, treated with externalized SCS, participated in a blocked functional magnetic resonance imaging design with stimulation and rest phases of 30 s each, repeated eight times in a row. During scanning, patients rated pain intensity over time using an 11-point numerical rating scale with verbal anchors (0 = no pain at all to 10 = worst pain imaginable) by pushing buttons (left hand, lesser pain; right hand, more pain). This scale was back projected to the patients on a flat screen allowing them to manually direct the pain indicator. To increase the signal-to-noise ratio, the 8-min block measurements were repeated three times. Results Marked deactivation of the bilateral medial thalamus and its connections to the rostral and caudal cingulate cortex and the insula was found; the study also showed immediate pain relief obtained by short-term SCS correlated negatively with activity in the inferior olivary nucleus, the cerebellum, and the rostral anterior cingulate cortex. Conclusions Results indicate the key role of the medial thalamus as a mediator and the involvement of a corticocerebellar network implicating the modulation and regulation of averse and negative affect related to pain. The observation of a deactivation of the ipsilateral antero-medial thalamus might be used as a region of interest for further response SCS studies.
ISSN:0028-3940
1432-1920
DOI:10.1007/s00234-012-1087-8