Proteomic analysis of cerebrospinal fluid gives insight into the pain relief of spinal cord stimulation

2013 ◽  
Vol 4 (4) ◽  
pp. 257-258 ◽  
Author(s):  
Anne-Li Lind ◽  
Magnus Wetterhall ◽  
Marcus Sjödin ◽  
Torsten Gordh
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Statistical Tests ◽  
Cost Effective ◽  
Structural Similarity ◽  
Cost Effective Treatment ◽  
Pain Patients

AbstractAimsNeuropathic pain is caused by a lesion or disease of the somatosensory nervous system affecting approximately 2% of the population. Current pharmacological treatments are ineffective for more than 50% of the patients and often give much adverse effects. Spinal cord stimulation (SCS) is an alternative cost-effective treatment with high efficacy, prolonged pain relief, few side effects. We have compared the cerebrospinal fluid (CSF) proteomes from neuropathic pain patients during pain relief induced by SCS and during pain sensation without SCS, to gain further insights into the mechanisms behind the obtained analgesia.MethodsPaired CSF samples were taken from SCS-responsive neuropathic pain patients after the SCS had been turned off for 48 h and when the SCS had been used normally for three weeks. Thus, each patient acted as their own control. The corresponding proteomes for each patient were relatively quantified using a mass spectrometry based shotgun approach.ResultsIn total, 419 unique proteins were simultaneously identified and relatively quantified. A panel consisting of seven proteins, 5 up-regulated and 2 down, were found to be significantly regulated by SCS in two complementary statistical tests (P ≤ 0.01). The most up-regulated protein in the SCS linked panel is a known modulator of nicotinic acetylcholine (ACh) receptor activity. Interestingly, it has a striking tertiary structural similarity and biological functionality as pain modulating prototoxins found in snake venoms.ConclusionsOur findings reveal possible insights into the mechanism of spinal cord stimulation and the obtained pain relief.

scholarly journals Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

2017 ◽  
Vol 7 (2) ◽  
pp. 68-79 ◽  
Author(s):  
Bruno Camporeze ◽  
Renata Faria Simm ◽  
Iracema Araújo Estevão ◽  
Luis Roberto Mathias Junior ◽  
Paulo Henrique Pires de Aguiar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Cost Effective ◽  
Medical Conditions ◽  
Reduction Of Pain ◽  
Bibliographic Search

Introduction: The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although, many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review. Methods: Bibliographic search of references from 1950 to 2016 using the databases MEDLINE, LILACS, SciELO, PubMed, and applied language as selection criteria, choosing preferably recent articles written in Portuguese, Spanish or English. Results: Based on literature review, SCS is a safe, reversible, adjustable and nondestructive surgical procedure demonstrating a significant effect in the reduction of pain intensity and improvement in quality of life in these patients. Furthermore, in spite of the initial high cost to its application, SCS has been associated with lower rates of complications and high rates of cost-effectiveness when compared to standard therapies. Conclusion: Although used in medical conditions with different etiology, the procedure is still an effective and a cost-effective approach to neuropathic pain, mainly in patients affected by failed back pain syndrome (FBSS) and complex regional pain syndrome (CRPS).

Choice of spinal cord stimulation versus targeted drug delivery in the management of chronic pain: a predictive formula for outcomes

2020 ◽  
pp. rapm-2019-100859
Author(s):  
Nagy Mekhail ◽  
Diana S Mehanny ◽  
Sherif Armanyous ◽  
Shrif Costandi ◽  
Youssef Saweris ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Spinal Cord ◽  
Pain Relief ◽  
Targeted Drug Delivery ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Cleveland Clinic ◽  
Cost Effective ◽  
Implantable Devices ◽  
Targeted Drug

Contemporary nonmalignant pain treatment algorithms commence with conservative non-invasive strategies, later progressing from minimally invasive interventions to invasive techniques or implantable devices. The most commonly used implantable devices are spinal cord stimulation (SCS) systems or targeted drug delivery (TDD) devices. Historically, SCS had been considered in advance of TDD, positioning TDD behind SCS failures. Following Institutional Review Board approval, data were extracted from electronic medical records of patients who underwent SCS trial in the Department of Pain Management at Cleveland Clinic from 1994 to 2013. The sample size was analyzed in two cohorts: those who succeeded with SCS and those who failed SCS and consequently proceeded to TDD. Univariate and multivariate analyses were performed and a predictive formula for successful outcomes was created. 945 patients were included in the cohort of which 119 (12.6%) subjects achieved adequate pain relief with TDD after failure of SCS. Gender, age, depression and primary pain diagnosis were significantly different in this subgroup. Males were 52% less likely to experience pain relief with SCS. The odds of SCS success decreased as age increased by 6% per year. Patients with comorbid depression, interestingly, were 63% more likely to succeed with SCS. A logistic model was created to predict SCS success which was used to create a predictive formula. Older male patients diagnosed with spine-related pain were more likely to benefit from TDD than SCS. This observation potentially identifies a subgroup in whom consideration for TDD in advance of SCS failure could prove more efficient and cost effective. These retrospective findings warrant prospective comparative studies to validate this derived predictive formula.

scholarly journals Pain relief and opioid usage in upper limb and neck pain patients after 10-kHz spinal cord stimulation treatment: subanalysis of USA studies

2020 ◽  
Author(s):  
Kasra Amirdelfan ◽  
Ricardo Vallejo ◽  
Ramsin Benyamin ◽  
Steven Rosen ◽  
Peter Kosek ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Neck Pain ◽  
Spinal Cord Stimulation ◽  
Opioid Consumption ◽  
Upper Limbs ◽  
Opioid Use ◽  
Scale Scores ◽  
Post Hoc ◽  
Pain Patients

Aim: It is argued that chronic pain patients who reduce/eliminate their opioids may have compromised pain relief. This study therefore aimed to analyze if reduced opioid consumption associated with 10-kHz spinal cord stimulation adversely affected pain relief. Methods: Post hoc analysis was performed on data from two prospective studies in subjects with upper limbs and neck pain conducted in USA. Results & conclusion: A 10-kHz spinal cord stimulation treatment was associated with reduction in mean visual analog scale scores for upper limbs and neck pain and mean daily opioid consumption. Pain scores decreased in subjects who decreased opioid use and in those who maintained/increased use. Opioid reduction and pain relief was also achieved in subjects taking >90 mg morphine equivalents of opioids at baseline.

Intrathecal Clonidine and Baclofen Enhance the Pain-Relieving Effect of Spinal Cord Stimulation

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 173-181 ◽  
Author(s):  
Gastón Schechtmann ◽  
Göran Lind ◽  
Jaleh Winter ◽  
Björn A. Meyerson ◽  
Bengt Linderoth
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Animal Experiments ◽  
Pain Reduction ◽  
Saline Control ◽  
Similar Data ◽  
Intrathecal Clonidine

Abstract OBJECTIVE Spinal cord stimulation (SCS) is a well-established treatment for neuropathic pain; nevertheless, 40% of patients fail to obtain satisfactory pain relief and in many patients, the effect tends to diminish with time. Based on animal experiments, intrathecal baclofen was previously introduced clinically to enhance suboptimal SCS effects. Later animal experiments demonstrated similar data for clonidine. The aim of this study was to elucidate whether intrathecal clonidine or baclofen enhances the effect of SCS in neuropathic pain patients in whom the pain relieving-effect of SCS is inadequate. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted with 10 patients experiencing neuropathic pain with insufficient pain relief with SCS alone. Clonidine, baclofen, and saline (control) were intrathecally administered by bolus injections in combination with SCS. RESULTS Seven of 10 patients reported significant pain reduction when SCS was combined with active drugs. The mean visual analog scale ratings were reduced by more than 50% with either drug combined with SCS. Four patients previously treated with SCS alone later underwent implantation of a pump for long-term administration of clonidine or baclofen. In the 2 patients with clonidine pumps with a mean follow-up of 15 months, the combined therapy produced pain reduction of 55% and 45%, respectively. The corresponding effect with baclofen was 32% and 82%, respectively, at 7 months follow-up. CONCLUSION A trial with clonidine and baclofen combined with SCS may be warranted in patients who do not obtain satisfactory pain relief with SCS alone or experienced a decreasing therapeutic effect.

Benzodiazepine Use Is Associated With Poorer Spinal Cord Stimulation Outcome in 373 Neuropathic Pain Patients

2019 ◽  
Vol 23 (5) ◽  
pp. 646-652 ◽  
Author(s):  
Jaakko Määttä ◽  
Antti Martikainen ◽  
Tiina‐Mari Ikäheimo ◽  
Mette Nissen ◽  
Heimo Viinamäki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Benzodiazepine Use ◽  
Pain Patients

New players in the mechanism of spinal cord stimulation for neuropathic pain

2015 ◽  
Vol 8 (1) ◽  
pp. 52-52 ◽  
Author(s):  
A. Lind ◽  
P. Emami ◽  
M. Sjödin ◽  
L. Katila ◽  
M. Wetterhall ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Test Statistics ◽  
Label Free ◽  
Novel Proteins ◽  
Proteomic Approach ◽  
Extracellular Matrix Components ◽  
Limma Package ◽  
Pain Patients

Abstract Aims The aim of this study was to uncover possible proteins involved in the mechanism for neuropathic spinal cord stimulation (SCS) pain relief in humans. Methods Using two different proteomic protocols we compared the protein concentration in cerebrospinal fluid (CSF) from 14 SCS responsive neuropathic pain patients using a shotgun proteomic approach. The comparison was made between samples from the same individual taken when the stimulator had been off for 48 h, and after the stimulator had been used as normal for three weeks. Mass spectrometry raw files from both experimental setups were analysed using MS Quant and DeCyder softwares and proteins were identified using MASCOT search against Swissprot database. After median normalization moderate paired t-test statistics were used in R limma package to find up-and down regulated proteins. Results In total, 255 and 216 proteins could be identified by the dimethyl and label free methods respectively and relatively quantified. Of these several were significantly up- and down regulated. Conclusions These novel proteins add to the SCS mechanism in patients with neuropathic pain. These results strengthen the evidence for SCS as altering extracellular matrix components and affecting central nervous system plasticity.

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