Epidural Spinal Cord Stimulation Does Not Improve Microvascular Blood Flow in Neuropathic Pain

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution Surgut Clinical Trauma Hospital. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome). Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the Pain Detect questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation. Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements. Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

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Epidural Spinal Cord Stimulation for Neuropathic Pain: Algology Unit in Bagcilar Training and Research Hospital Data Collection and Analysis

Spine Research ◽

10.21767/2471-8173.100017 ◽

2016 ◽

Vol 02 (02) ◽

Author(s):

Abdulkadir YektaA

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Data Collection ◽

Spinal Cord Stimulation ◽

Hospital Data ◽

Research Hospital ◽

Data Collection And Analysis ◽

Epidural Spinal Cord Stimulation ◽

Training And Research

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Alteration of regional cerebral blood flow in patients with chronic pain —Evaluation before and after epidural spinal cord stimulation—

Annals of Nuclear Medicine ◽

10.1007/bf02984647 ◽

2006 ◽

Vol 20 (4) ◽

pp. 303-310 ◽

Cited By ~ 25

Author(s):

Shigeki Nagamachi ◽

Seigo Fujita ◽

Ryuichi Nishii ◽

Shigemi Futami ◽

Hideyuki Wakamatsu ◽

...

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Spinal Cord Stimulation ◽

Regional Cerebral Blood Flow ◽

Regional Cerebral Blood ◽

Pain Evaluation ◽

Before And After ◽

Epidural Spinal Cord Stimulation

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Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

Brain Sciences ◽

10.3390/brainsci8080138 ◽

2018 ◽

Vol 8 (8) ◽

pp. 138 ◽

Cited By ~ 19

Author(s):

Ivano Dones ◽

Vincenzo Levi

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

Therapeutic Option ◽

Neural Pathways ◽

Chronic Neuropathic Pain ◽

Pain Medications ◽

Epidural Spinal Cord Stimulation ◽

Pain Therapists ◽

Effective Drugs

The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

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Hypoxia induced carbonic anhydrase mediated dorsal horn sensory neuron activation and induction of neuropathic pain

10.1101/2021.06.08.447539 ◽

2021 ◽

Author(s):

Marlene E Da Vitoria Lobo ◽

Nick Weir ◽

Lydia Hardowar ◽

Yara Al Ojaimi ◽

Ryan Madden ◽

...

Keyword(s):

Spinal Cord ◽

Blood Flow ◽

Neuropathic Pain ◽

Carbonic Anhydrase ◽

Dorsal Horn ◽

Sensory Neurons ◽

Glucose Transporter ◽

Growth Factor Receptor ◽

Spinal Cord Dorsal Horn ◽

Microvascular Blood Flow

Neuropathic pain such as that seen in diabetes mellitus, results in part from central sensitisation in the spinal cord dorsal horn. However, the mechanisms responsible for such sensitisation remain unclear. There is evidence that disturbances in the integrity of the spinal vascular network can be a causative factor in the development of neuropathic pain. Here we show that reduced blood flow and vascularity of the dorsal horn leads to the onset of neuropathic pain. Using rodent models (type 1 diabetes and an inducible endothelial specific vascular endothelial growth factor receptor 2 knockout mouse) that result in degeneration of the endothelium in the dorsal horn we show that spinal cord vasculopathy results in nociceptive behavioural hypersensitivity. This also results in increased hypoxia in dorsal horn sensory neurons, depicted by increased expression of hypoxia markers hypoxia inducible factor 1𝛼, glucose transporter 3 and carbonic anhydrase 7. Furthermore, inducing hypoxia via intrathecal delivery of dimethyloxalylglycine leads to the activation of dorsal horn sensory neurons as well as mechanical and thermal hypersensitivity. This shows that hypoxic signalling induced by reduced vascularity results in increased hypersensitivity and pain. Inhibition of carbonic anhydrase activity, through intraperitoneal injection of acetazolamide, inhibited hypoxia induced pain behaviours. This investigation demonstrates that induction of a hypoxic microenvironment in the dorsal horn, as occurs in diabetes, is an integral process by which sensory neurons are activated to initiate neuropathic pain states. This leads to the conjecture that reversing hypoxia by improving spinal cord microvascular blood flow could reverse or prevent neuropathic pain.

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