Department of Neurosurgery, Eberhard-Karls University, Tuebingen, Germany.
Pain Physician. 2022 Aug;25(5):373-380.
In the presence of neuropathic pain, other sensory qualities, such as touch or pressure, which are a sign of nerve damage, are almost always affected. However, it is unclear to which extent spinal cord stimulation (SCS) influences these simultaneously damaged sensory pathways or possibly contributes to their regeneration.
The aim of this study was to investigate the effects and possible differences of tonic and BurstDR (Abbott, Austin, TX) SCS on somatosensory profiles of patients with chronic neuropathic pain, using quantitative sensory testing (QST).
A randomized, single-blinded, single-center study.
University medical center.
After a washout phase of 4 hours and having done the basic QST measurement, either tonic or BurstDR stimulation was performed for 30 minutes in a randomized fashion. Then, the second measurement was taken. The third measurement followed after using the remaining stimulation mode for 30 minutes. Mean values of all QST parameters were calculated and compared. We also computed Z-values using standard data.
We examined 14 patients (9 women, 5 men, mean age 58.4 years) with previously implanted SCS systems for chronic neuropathic pain, using QST (7 tests, 13 parameters).The QST raw data showed a statistically significant improved vibration sensation (A-Beta) (P = 0.019) and lower mechanical pain threshold (A-Delta) (P = 0,031) when testing BurstDR in comparison to tonic SCS. We found a significant improvement in the vibration sensation and also A-Beta fiber function during BurstDR when we used the Z-value analysis (P = 0.023). With regard to Z-values, BurstDR seemed to be superior regarding the normalization tendency of the A-Delta fiber function in the mechanical pain threshold (P = 0.082), and tonic SCS seemed superior regarding heat detection threshold (C) and cold pain threshold (C and A-Delta) (P = 0.093).
The study is limited by its small number of cases.
In this study, it could be shown that, in some QST parameters and tested fiber functions, normalization tendencies were recognizable by using BurstDR or tonic SCS. However, BurstDR SCS seemed to be superior to tonic stimulation in this regard.
在存在神经病理性疼痛的情况下，其他感觉质量，如触摸或压力，这些都是神经损伤的迹象，几乎总是受到影响。然而，尚不清楚脊髓刺激（SCS）在多大程度上影响这些同时受损的感觉通路，或者是否有助于它们的再生。
本研究旨在使用定量感觉测试（QST）研究慢性神经病理性疼痛患者的强直和 BurstDR（Abbott，Austin，TX）SCS 对躯体感觉分布的影响及其可能的差异。
随机、单盲、单中心研究。
大学医学中心。
在 4 小时洗脱期后，进行基本 QST 测量，然后以随机方式进行强直或 BurstDR 刺激 30 分钟。然后进行第二次测量。在使用剩余的刺激模式 30 分钟后，进行第三次测量。计算并比较所有 QST 参数的平均值。我们还使用标准数据计算了 Z 值。
我们检查了 14 名（9 名女性，5 名男性，平均年龄 58.4 岁）先前植入 SCS 系统用于慢性神经病理性疼痛的患者，使用 QST（7 项测试，13 项参数）。QST 原始数据显示，与强直 SCS 相比，BurstDR 测试时振动感觉（A-Beta）（P = 0.019）和较低的机械痛阈（A-Delta）（P = 0.031）有统计学显著改善。我们发现，在使用 Z 值分析时，BurstDR 对振动感觉和 A-Beta 纤维功能的改善具有统计学意义（P = 0.023）。关于 Z 值，BurstDR 在机械痛阈的 A-Delta 纤维功能的归一化趋势方面似乎更具优势（P = 0.082），而强直 SCS 在热探测阈值（C）和冷痛阈值（C 和 A-Delta）方面似乎更具优势（P = 0.093）。
该研究受到病例数量的限制。
在这项研究中，我们可以证明，在一些 QST 参数和测试的纤维功能中，使用 BurstDR 或强直 SCS 可以识别出归一化趋势。然而，在这方面，BurstDR SCS 似乎优于强直刺激。
