The influence of High Dose Spinal Cord Stimulation on the descending pain modulatory system in patients with failed back surgery syndrome

Sander De Groote, Lisa Goudman, Ronald Peeters, Bengt Linderoth, Peter Van Schuerbeek, Stefan Sunaert, Mats De Jaeger, Ann De Smedt, José De Andrés, Maarten Moens, Sander De Groote, Lisa Goudman, Ronald Peeters, Bengt Linderoth, Peter Van Schuerbeek, Stefan Sunaert, Mats De Jaeger, Ann De Smedt, José De Andrés, Maarten Moens

Abstract

  1. •

    For the first time, the influence of HD-SCS on the descending pathways was tested.

  2. •

    rsfMRI and functional connectivity were used to evaluate this a priori hypothesis.

  3. •

    HD-SCS does influence the descending pain modulatory system.

Conflict of interest statement

S. De Groote PT: no conflicts of interest to disclose L. Goudman MSc PhD: no conflicts of interest to disclose R. Peeters MSc PhD: no conflicts of interest to disclose B. Linderorth MD PhD: Bengt Linderoth serves as a consultant to Medtronic, St Jude, Boston Sci and Elekta AB. P. Vanschuerbeek MSc PhD: no conflicts of interest to disclose S. Sunaert MD PhD: no conflicts of interest to disclose M. De Jaeger PT: no conflicts of interest to disclose A. De Smedt MD PhD: no conflicts of interest to disclose J. De Andrés MD PhD FIPP EDRA EDPM: no conflicts of interest to disclose M. Moens MD PhD: Maarten Moens has received speaker fees from Medtronic and Nevro Corp. There is no other conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Study protocol. Patients with FBSS were enrolled 1 month before SCS trial implantation and were followed up for 3 months after permanent implantation. Every patient underwent a neuroimaging protocol at baseline and during HD-SCS. Abbreviations. AW: Actiwatch, HD-SCS: High Dose Spinal Cord Stimulation, Q:questionnaires, V: visit.
Fig. 2
Fig. 2
Boxplots of the clinical results of NRS, PCS and PSQI scores and actigraphy variables of all patients. Gray and green boxes are representing respectively baseline data and data after 3 months of SCS. Abbreviations: NRS: numeric rating scale, PCS: pain catastrophizing scale, PSQI: Pittsburgh sleep quality index.
Fig. 3
Fig. 3
ROI-ROI matrices, visualization of functional connectivity in resting state networks. A) Differences of the functional connectivity strength in ROI-pairs between HD-SCS vs baseline in all 11 patients are shown in the ROI-ROI matrices. B) The significant results (p

Fig. 4

Effect size of functional connectivity…

Fig. 4

Effect size of functional connectivity in ROI-pairs before SCS and during HD-SCS. During…

Fig. 4
Effect size of functional connectivity in ROI-pairs before SCS and during HD-SCS. During HD-SCS, there is a significant increase in functional connectivity strength in 3 ROI-pairs (mFG left – mFG right, mFG left – RVM, mFG right – AI left) and a decrease in ACC – AI right strength. *: p<0.05. Abbreviations. ACC: anterior cingulate cortex, Al: anterior insula, mFG: middle frontal gyrus, RVM: rostro ventromedial medulla.
Fig. 4
Fig. 4
Effect size of functional connectivity in ROI-pairs before SCS and during HD-SCS. During HD-SCS, there is a significant increase in functional connectivity strength in 3 ROI-pairs (mFG left – mFG right, mFG left – RVM, mFG right – AI left) and a decrease in ACC – AI right strength. *: p<0.05. Abbreviations. ACC: anterior cingulate cortex, Al: anterior insula, mFG: middle frontal gyrus, RVM: rostro ventromedial medulla.

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