Spinal Cord Stimulation in Patients With Complex Regional Pain Syndrome: A Possible Target for Immunomodulation?
Objective Complex regional pain syndrome (CRPS) is characterized by continued pain disproportional to the inciting event, sensory abnormalities, vasomotor and sudomotor disturbances, and motor and trophic changes. Inflammatory involvement has been demonstrated in past CRPS studies resulting in pain,...
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Published in | Neuromodulation (Malden, Mass.) Vol. 21; no. 1; pp. 77 - 86 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Limited
01.01.2018
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Subjects | |
Online Access | Get full text |
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Summary: | Objective
Complex regional pain syndrome (CRPS) is characterized by continued pain disproportional to the inciting event, sensory abnormalities, vasomotor and sudomotor disturbances, and motor and trophic changes. Inflammatory involvement has been demonstrated in past CRPS studies resulting in pain, swelling, and warmth. Currently, it is unknown whether spinal cord stimulation (SCS) has immunomodulatory properties. The aim of this study was to determine whether SCS has immunomodulatory properties in CRPS patients.
Methods
The primary outcome parameters are cytokines (IL‐2, IL‐4, IL‐5, IL‐6, IL‐10, IL‐12, IL‐13, IL‐15, IL‐17, TNF‐α, IFN‐γ), chemokines (IP‐10 and Eotaxin), and growth factors (VEGF, PDGFbb, and basic FGF) from interstitial fluid of artificial skin blisters before (T0—baseline without SCS) and after SCS therapy (T1—40 Hz standard frequency stimulation and T2—preferred frequency stimulation). Secondary outcome parameters were baseline demographics, CRPS signs, symptoms, and phenotype (inflammatory, vasomotor, dystonia, or neuropathic). Results were analyzed by means of a MANOVA repeated measures design.
Results
After SCS, the expression of both pro‐ and anti‐inflammatory cytokines decreased over time in both the CRPS affected extremity and the contralateral extremity. The levels of IP‐10, Eotaxin, VEGF, and PDGFbb were also significantly reduced bilaterally. There were no significant changes in IL‐6 and TNF‐α before and after SCS. The sensory signs, symptoms, and phenotype improved after SCS.
Discussion
SCS in CRPS patients attenuates T‐cell activation, improves peripheral tissue oxygenation and decreases anti‐angiogenetic activity which results in diminished endothelial dysfunction and improved bloodflow. The possible immunomodulatory effects of SCS opens new therapeutic possibilities in diseases with the involvement of the immune system and vasomotor disturbances, and requires further research on these mechanisms of action. |
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Bibliography: | For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to Conflict of Interest Frank Huygen is an advisory board member for both “Change Pain” from Grünenthal and Abbot. The remaining authors declare no conflict of interest. Source(s) of funding support: This investigator‐initiated study was supported by a grant from St. Jude Medical (Plano, TX, USA). Our research group independently performed the design, performance, analysis, and submission of this trial. http://www.wiley.com/WileyCDA/Section/id-301854.html ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23 |
ISSN: | 1094-7159 1525-1403 |
DOI: | 10.1111/ner.12704 |