Compound action potentials recorded in the human spinal cord during neurostimulation for pain relief

• Published in: Pain (Amsterdam) Vol. 153; no. 3; pp. 593 - 601
• Main Authors: Parker, John L., Karantonis, Dean M., Single, Peter S., Obradovic, Milan, Cousins, Michael J.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier B.V 01.03.2012; Lippincott Williams & Wilkins, Inc; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Biophysics; Electric Stimulation Therapy - methods; Electrocardiography - methods; Electrodes; Epidural Space - physiology; Evoked Potentials - physiology; Female; Fundamental and applied biological sciences. Psychology; Humans; Illness and personality; Illness, stress and coping; Middle Aged; Neural Conduction - physiology; Neuralgia - pathology; Neuralgia - therapy; Neuromodulation; Neuropathic pain; Physiological measurement; Posture; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Reaction Time; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Spinal Cord - physiology; Spinal cord stimulation; Time Factors; Vertebrates: nervous system and sense organs; Physiological measurement; Neuromodulation; Spinal cord stimulation; Neuropathic pain; Human; Dorsal column; Spinal cord; Electrical stimulus; Central nervous system; Electrophysiology; Axon; Action potential; Long term; Electrodes; Experience; Pain; Neuron; Perception; Mechanism of action
• ISSN: 0304-3959; 1872-6623; 1872-6623
• DOI: 10.1016/j.pain.2011.11.023

Aβ sensory nerve fibres are recruited during therapeutic spinal cord stimulation and the Aβ potential amplitude correlates with the degree of coverage of the painful area. Electrical stimulation of the spinal cord provides effective pain relief to hundreds of thousands of chronic neuropathic pain sufferers. The therapy involves implantation of an electrode array into the epidural space of the subject and then stimulation of the dorsal column with electrical pulses. The stimulation depolarises axons and generates propagating action potentials that interfere with the perception of pain. Despite the long-term clinical experience with spinal cord stimulation, the mechanism of action is not understood, and no direct evidence of the properties of neurons being stimulated has been presented. Here we report novel measurements of evoked compound action potentials from the spinal cords of patients undergoing stimulation for pain relief. The results reveal that Aβ sensory nerve fibres are recruited at therapeutic stimulation levels and the Aβ potential amplitude correlates with the degree of coverage of the painful area. Aβ-evoked responses are not measurable below a threshold stimulation level, and their amplitude increases with increasing stimulation current. At high currents, additional late responses are observed. Our results contribute towards efforts to define the mechanism of spinal cord stimulation. The minimally invasive recording technique we have developed provides data previously obtained only through microelectrode techniques in spinal cords of animals. Our observations also allow the development of systems that use neuronal recording in a feedback loop to control neurostimulation on a continuous basis and deliver more effective pain relief. This is one of numerous benefits that in vivo electrophysiological recording can bring to a broad range of neuromodulation therapies.