Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients.

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY Pain and Therapy Pub Date : 2024-12-01 Epub Date: 2024-10-18 DOI:10.1007/s40122-024-00670-x

Carolyn Riera, Daniela Souza de Oliveira, Matthias Borutta, Martin Regensburger, Yining Zhao, Steffen Brenner, Alessandro Del Vecchio, Thomas M Kinfe

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Abstract

Introduction: Spinal cord stimulation (SCS) represents an established interventional pain therapeutic; however, the SCS effects of SCS waveforms on motor neuron recruitment of the lower limbs of chronic pain patients remain largely unknown.

Methods: We investigated these effects by performing isometric ankle-dorsal flexions at varying force levels under four SCS conditions: SCS Off (1 week), burst SCS (40 Hz), SCS Off (acute), and tonic SCS (130 Hz). Muscle activity was recorded via high-density surface electromyography (64-electrode grid) on the tibialis anterior muscle. Motor unit action (MUs) potentials were analyzed for recruitment and de-recruitment thresholds, discharge rate, inter-spike interval, and common synaptic input.

Results: In this prospective study, we included nine patients (five females; four males; mean age 59 years) with chronic pain treated with thoracic (Th7-Th8) epidural spinal stimulation. A total of 97 MUs were found for 15% maximal voluntary torque (MVT) and 83 for 30%MVT, an average of 10.8 ± 3.7 for 15%MVT and 10.4 ± 3.5 for 30%MVT. While a few subject-specific variations were observed, our study suggests that the different SCS frequencies applied do not significantly influence motor unit discharge characteristics in the TA muscle among the participants (p values at 15%MVT were 0.586 (Chi² = 1.933), 0.737 (Chi² = 1.267), 0.706 (Chi² = 1.4) and 0.586 (Chi² = 1.933), respectively. The p values of the Friedman test at 30%MVT were 0.896 (Chi² = 0.6), 0.583 (Chi² = 1.95), 0.896 (Chi² = 0.6) and 0.256 (Chi² = 4.05). No significant difference was found for the different stimulation types for the delta (0-5 Hz), alpha (5-12 Hz), and beta (15-30 Hz) bands at both force levels.

Conclusions: In summary, we did not observe any changes in motor unit oscillatory activity at any low and high bandwidths, indicating that SCS using different waveforms (tonic/burst) does not significantly influence motor neuron recruitment for non-motor individuals with chronic pain.

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慢性疼痛患者远端运动神经元对非靶向胸椎脊髓刺激的反应未发生改变

简介：脊髓刺激（SCS）是一种成熟的介入性疼痛治疗方法；然而，SCS 波形对慢性疼痛患者下肢运动神经元募集的影响在很大程度上仍然未知：我们通过在四种 SCS 条件下以不同的力量水平进行踝关节背侧等长屈伸来研究这些影响：SCS关闭（1周）、爆发性SCS（40赫兹）、SCS关闭（急性）和强直性SCS（130赫兹）。通过胫骨前肌的高密度表面肌电图（64 个电极网格）记录肌肉活动。对运动单位动作（MUs）电位的募集和去募集阈值、放电率、棘间期和共同突触输入进行了分析：在这项前瞻性研究中，我们纳入了九名接受胸椎（Th7-Th8）硬膜外脊柱刺激治疗的慢性疼痛患者（五名女性；四名男性；平均年龄 59 岁）。15% 最大自主转矩 (MVT) 和 30% 最大自主转矩 (MVT) 的 MU 分别为 97 和 83，15% 最大自主转矩 (MVT) 和 30% 最大自主转矩 (MVT) 的平均值分别为 10.8 ± 3.7 和 10.4 ± 3.5。虽然观察到了一些特定受试者的差异，但我们的研究表明，不同的 SCS 频率并不会显著影响受试者 TA 肌肉的运动单元放电特征（15%MVT 的 p 值分别为 0.586（Chi2 = 1.933）、0.737（Chi2 = 1.267）、0.706（Chi2 = 1.4）和 0.586（Chi2 = 1.933）。在 30%MVT 时，Friedman 检验的 p 值分别为 0.896（Chi2 = 0.6）、0.583（Chi2 = 1.95）、0.896（Chi2 = 0.6）和 0.256（Chi2 = 4.05）。在两种力量水平下，δ（0-5赫兹）、α（5-12赫兹）和β（15-30赫兹）波段的不同刺激类型没有发现明显差异：总之，我们在任何低带宽和高带宽下都没有观察到运动单元振荡活动的任何变化，这表明使用不同波形（强直/爆发）的 SCS 不会显著影响非运动型慢性疼痛患者的运动神经元募集。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.