Departments of 1 Neurosurgery and.
Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, New York.
J Neurosurg. 2017 Feb;126(2):397-403. doi: 10.3171/2016.2.JNS152231. Epub 2016 Apr 22.
OBJECTIVE Chronic pain is a major distressing symptom of Parkinson's disease (PD) that is often undertreated. Subthalamic nucleus (STN) deep brain stimulation (DBS) delivers high-frequency stimulation (HFS) to patients with PD and has been effective in pain relief in a subset of these patients. However, up to 74% of patients develop new pain concerns while receiving STN DBS. Here the authors explore whether altering the frequency of STN DBS changes pain perception as measured through quantitative sensory testing (QST). METHODS Using QST, the authors measured thermal and mechanical detection and pain thresholds in 19 patients undergoing DBS via HFS, low-frequency stimulation (LFS), and off conditions in a randomized order. Testing was performed in the region of the body with the most pain and in the lower back in patients without chronic pain. RESULTS In the patients with chronic pain, LFS significantly reduced heat detection thresholds as compared with thresholds following HFS (p = 0.029) and in the off state (p = 0.010). Moreover, LFS resulted in increased detection thresholds for mechanical pressure (p = 0.020) and vibration (p = 0.040) compared with these thresholds following HFS. Neither LFS nor HFS led to changes in other mechanical thresholds. In patients without chronic pain, LFS significantly increased mechanical pain thresholds in response to the 40-g pinprick compared with thresholds following HFS (p = 0.032). CONCLUSIONS Recent literature has suggested that STN LFS can be useful in treating nonmotor symptoms of PD. Here the authors demonstrated that LFS modulates thermal and mechanical detection to a greater extent than HFS. Low-frequency stimulation is an innovative means of modulating chronic pain in PD patients receiving STN DBS. The authors suggest that STN LFS may be a future option to consider when treating Parkinson's patients in whom pain remains the predominant complaint.
慢性疼痛是帕金森病（PD）的一种主要痛苦症状，通常治疗不足。丘脑底核（STN）深部脑刺激（DBS）为 PD 患者提供高频刺激（HFS），并已在这些患者的一部分中有效缓解疼痛。然而，高达 74%的患者在接受 STN DBS 时出现新的疼痛问题。在这里，作者探索改变 STN DBS 的频率是否会改变通过定量感觉测试（QST）测量的疼痛感知。方法：作者使用 QST，通过 HFS、低频刺激（LFS）和关闭条件，以随机顺序测量了 19 名接受 DBS 的患者的热和机械检测和疼痛阈值，在身体疼痛最严重的区域和没有慢性疼痛的患者的下背部进行测试。结果：在患有慢性疼痛的患者中，与 HFS 后（p = 0.029）和关闭状态（p = 0.010）相比，LFS 显著降低了热检测阈值。此外，与 HFS 后相比，LFS 导致机械压力（p = 0.020）和振动（p = 0.040）的检测阈值增加。LFS 和 HFS 均未导致其他机械阈值发生变化。在没有慢性疼痛的患者中，与 HFS 后相比，LFS 显著增加了对 40 克针刺的机械疼痛阈值（p = 0.032）。结论：最近的文献表明，STN LFS 可用于治疗 PD 的非运动症状。在这里，作者证明 LFS 比 HFS 更能调节热和机械检测。LFS 是一种调节接受 STN DBS 的 PD 患者慢性疼痛的创新方法。作者建议，当治疗疼痛仍然是主要抱怨的帕金森病患者时，STN LFS 可能是一个需要考虑的未来选择。
