Meuwissen Koen P V, Gu Jianwen Wendy, Zhang Tianhe C, Joosten Elbert A J
Pain Management and Research Centre, Department of Anesthesiology and Pain Management, MUMC+, Maastricht, The Netherlands.
School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Neuromodulation. 2018 Jan;21(1):19-30. doi: 10.1111/ner.12731. Epub 2017 Nov 27.
Various spinal cord stimulation (SCS) modes are used in the treatment of chronic neuropathic pain disorders. Conventional (Con) and Burst-SCS are hypothesized to exert analgesic effects through different stimulation-induced mechanisms. Preclinical electrophysiological findings suggest that stimulation intensity is correlated with the effectiveness of Burst-SCS. Therefore, we aimed to investigate the relation between amplitude (charge per second) and behavioral effects in a rat model of chronic neuropathic pain, for both Conventional Spinal Cord Stimulation (Con-SCS) and biphasic Burst-SCS.
Animals (n = 12 rats) received a unilateral partial sciatic nerve ligation, after which they were implanted with quadripolar electrodes in the epidural space at thoracic level 13. Mechanical hypersensitivity was assessed using paw withdrawal thresholds (WTs) to von Frey monofilaments, at various SCS intensities (amplitudes) and multiple time points during 60 minutes of stimulation and 30 minutes post stimulation.
Increasing amplitude was shown to improve the efficacy of Con-SCS, whereas the efficacy of Burst-SCS showed a non-monotonic relation with amplitude. Con-SCS at 66% MT (n = 5) and Burst-SCS at 50% MT (n = 6) were found to be equally effective in normalizing mechanical hypersensitivity. However, in the assessed time period Burst-SCS required significantly more mean charge per second to do so (p < 0.01). When applied at comparable mean charge per second, Con-SCS resulted in a superior behavioral outcome (p < 0.01), compared with Burst-SCS.
Biphasic Burst-SCS requires significantly more mean charge per second in order to achieve similar pain relief, as compared with Con-SCS, in an experimental model of chronic neuropathic pain.
多种脊髓刺激（SCS）模式用于治疗慢性神经性疼痛疾病。传统（Con）刺激模式和爆发式SCS被认为是通过不同的刺激诱导机制发挥镇痛作用。临床前电生理研究结果表明，刺激强度与爆发式SCS的有效性相关。因此，我们旨在研究在慢性神经性疼痛大鼠模型中，传统脊髓刺激（Con-SCS）和双相爆发式SCS的刺激幅度（每秒电荷量）与行为效应之间的关系。
动物（n = 12只大鼠）接受单侧部分坐骨神经结扎，之后在胸13水平的硬膜外间隙植入四极电极。在不同SCS强度（幅度）下，以及刺激60分钟期间和刺激后30分钟的多个时间点，使用对von Frey细丝的爪退缩阈值（WTs）评估机械性超敏反应。
刺激幅度增加可提高Con-SCS的疗效，而爆发式SCS的疗效与幅度呈非单调关系。发现在使机械性超敏反应恢复正常方面，66%运动阈值（MT）的Con-SCS（n = 5）和50% MT的爆发式SCS（n = 6）同样有效。然而，在评估时间段内，爆发式SCS为此所需的平均每秒电荷量显著更多（p < 0.01）。当以可比的平均每秒电荷量应用时，与爆发式SCS相比，Con-SCS产生了更好的行为结果（p < 0.01）。
在慢性神经性疼痛实验模型中，与Con-SCS相比，双相爆发式SCS为实现类似的疼痛缓解需要显著更多的平均每秒电荷量。
