Department of Pain Medicine, St James's Hospital, Dublin, Ireland.
Neuromodulation. 2013 Nov-Dec;16(6):519-22; discussion 522. doi: 10.1111/j.1525-1403.2012.00527.x. Epub 2012 Nov 8.
Spinal cord stimulation (SCS) is an efficacious therapy for chronic neuropathic pain whose precise mechanism of action is unclear. Mediators produced by glial and immune cells are now believed to modulate neuronal transmission and promote chronic neuropathic pain. We postulated a relationship between cerebrospinal fluid (CSF) concentrations of neuroimmune mediators and SCS.
We measured CSF concentrations of the chemokine, monocyte chemotactic protein-1 (MCP-1), and the growth factors, brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) and tested for relationships with stimulation parameters and clinical response in nine patients with failed back surgery syndrome (FBSS).
Patients with FBSS had higher CSF concentrations of BDNF (p = 0.01) and MCP-1 (p = 0.0001) than matched controls. CSF concentrations of BDNF and VEGF correlated with reported pain (p = 0.04). Five minutes of SCS resulted in a reduction in median VEGF concentrations (p = 0.01).
Patients with FBSS have altered CSF levels of BDNF and MCP-1. CSF VEGF correlates with pain and is reduced by SCS. This may offer novel insights into both the mechanism of action of SCS in FBSS and the variation in clinical response that may be encountered.
脊髓刺激（SCS）是一种有效的慢性神经性疼痛治疗方法，但其确切作用机制尚不清楚。现在认为神经胶质细胞和免疫细胞产生的介质可以调节神经元的传递，并促进慢性神经性疼痛。我们假设脑脊液（CSF）中神经免疫介质浓度与 SCS 之间存在关系。
我们测量了 9 例失败性脊柱手术后综合征（FBSS）患者脑脊液中趋化因子单核细胞趋化蛋白-1（MCP-1）和生长因子脑源性神经营养因子（BDNF）和血管内皮生长因子（VEGF）的浓度，并测试了它们与刺激参数和临床反应的关系。
FBSS 患者的 CSF 中 BDNF（p = 0.01）和 MCP-1（p = 0.0001）浓度高于匹配对照组。BDNF 和 VEGF 的 CSF 浓度与报告的疼痛相关（p = 0.04）。SCS 后 5 分钟，VEGF 中位数浓度降低（p = 0.01）。
FBSS 患者的 CSF 中 BDNF 和 MCP-1 水平发生改变。CSF VEGF 与疼痛相关，SCS 可降低 VEGF 浓度。这可能为 SCS 在 FBSS 中的作用机制以及可能遇到的临床反应变化提供新的见解。
