Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action

Caylor, Jacob; Reddy, Rajiv; Yin, Sopyda; Cui, Christina; Huang, Mingxiong; Huang, Charles; Rao, Ramesh; Baker, Dewleen G.; Simmons, Alan; Souza, Dmitri; Narouze, Samer; Vallejo, Ricardo; Lerman, Imanuel

doi:10.1186/s42234-019-0023-1

Bioelectronic Medicine

Table 4 Summary of QST clinical research investigating spinal cord stimulation (SCS) from inception to present

From: Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action

Mechanical						Thermal			Electrical
Study Authors	Year	SCS Paradigm	Sample Size	Detection Threshold	Pain Threshold	Detection Threshold	Pain Threshold	Pain Tolerance	Detection Threshold	Pain Threshold	Pain Tolerance	Temporal Summation	Comments
Shealy et al. (1970)	1970	P	6	↔									Hyperalgesia to pinprick after P-SCS but deep pressure less painful
Larson et al. (1974)	1975	P	18	↑	↑								Changes returned to control values within 30–60 min of cessation
Lindblom et al. (1975)	1975	P	5	↑	↔
Doerr et al. (1978)	1978	P	8	↑					↑	↑
Marchand et al. (1991)	1991	P	8			Warm: ↑	Warm: ↑
Mironer et al. (2000)	2000	P	44						↔	↔	↑		Tolerance correlated to success of trial stimulation and permanent P-SCS implant
Alo et al. (Aló & Chado, 2000)	2000	P	16						↑		↔
Kemler et al. (2001)	2001	P	24		↔	Warm: ↔ Cold: ↔	Warm: ↔ Cold: ↔						Mechanical detection thresholds returned to baseline after 3 months
Cata et al. (2004)	2004	P	2	↓			Warm: ↔ Cold: ↔						↓Sharpness detection
Eisenberg et al. (2006)	2006	P	13	↑		↔	↔			↑
Rasche et al. (2006)	2006	P	7	↓	↔	Warm: ↓ Cold: ↓	Warm: ↔ Cold: ↔						Thermal and mechanical detection and pain thresholds not statistically significant in unaffected limb
Van Eijs et al. (2010)	2010	P	24										Brush evoked allodynia is a negative prognostic factor of SCS treatment
Burkey et al. (2010)	2010	P	1			Warm: ↑ Cold: ↔
Munster et al. (2012)	2012	P	1	↓	↔	Warm: ↑ Cold: ↓	Warm: ↑ Cold: ↓
Meier et al. (2015)	2015	P	14	↔	↔	↔	↔						No change in wind-up
Ahmed et al. (2015)	2015	P	19			Warm: ↑	Warm: ↑	Warm: ↑
Youn et al. (2015)	2015	HF	20	↑	↑	↔	↔
Eisenberg et al. (2015)	2015	P	18									↓	↓TS at most painful site of affected leg; no effect on nonpainful leg
Campbell et al.(2015)	2015	P	24		↔		Heat: ↔	Heat: ↔				↓	↑TS and ↓CPM associated with ↓ self-reported pain
Biurrun Manresa et al.(2015)	2015	P	17							↔			↑ withdrawal reflex threshold; psychologic scores were predictors for electrical pain tolerance

Modern QST and dynamic QST has evolved considerably since the first trials demonstrating changes in threshold and tolerance. Despite early evidence demonstrating increased threshold and tolerance with P-SCS, recent studies diverge and are remarkably heterogenous in their findings. This is likely due to changes in methodology, equipment, patient factors and the evolution of SCS. Regardless, QST and dynamic QST offer a potentially exciting future avenue for investigation. Basic science applications include clarifying analgesic mechanisms of P-SCS and PF-SCS. Clinical application of QST may prove a useful tool for identifying SCS candidates and tailoring therapy to a particular patient or pain syndrome. ‘Up’ and ‘down’ arrows represent increases or decreases, respectively, in threshold or tolerance. ‘Sideways’ arrows represent no significant difference. Acronyms: P (P-SCS, paresthesia or tonic spinal cord stimulation), HF (HF-SCS, high frequency or kilohertz frequency spinal cord stimulation), TS (Temporal Summation), CPM (Conditioned Pain Modulation).

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ISSN: 2332-8886

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