Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation
Abstract Background In a previous study, we reported that selective dorsal root ganglion stimulation (DRGSTIM) at DRG level L4 promoted a favorable outcome for complex regional pain syndrome (CRPS) patients along with DRGSTIM-related changes of inflammatory biomarkers in blood and saliva. The impact...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | Journal of Translational Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12967-020-02566-8 |
| _version_ | 1818248988643557376 |
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| author | Thomas Kinfe Nico von Willebrand Andreas Stadlbauer Michael Buchfelder Thomas L. Yearwood Sajjad Muhammad Shafqat R. Chaudhry Sascha Gravius Thomas Randau Klemens Winder Christian Maihöfner Nadine Gravius Walter Magerl |
| author_facet | Thomas Kinfe Nico von Willebrand Andreas Stadlbauer Michael Buchfelder Thomas L. Yearwood Sajjad Muhammad Shafqat R. Chaudhry Sascha Gravius Thomas Randau Klemens Winder Christian Maihöfner Nadine Gravius Walter Magerl |
| author_sort | Thomas Kinfe |
| collection | DOAJ |
| description | Abstract Background In a previous study, we reported that selective dorsal root ganglion stimulation (DRGSTIM) at DRG level L4 promoted a favorable outcome for complex regional pain syndrome (CRPS) patients along with DRGSTIM-related changes of inflammatory biomarkers in blood and saliva. The impact on somatosensation is largely unknown. Herein, we assessed the quantitative sensory profile to quantify L4-DRGSTIM effects in CRPS patients. Methods Twelve refractory CRPS patients (4 female; 8 male; mean age 69 ± 9 years) received standardized quantitative sensory testing (QST) protocol at baseline and after 3 months of unilateral L4-DRGSTIM assessing nociceptive and non-nociceptive thermal and mechanical sensitivity of the knee affected by CRPS and the contralateral non-painful knee area. Results At baseline, CRPS subjects showed significantly increased thresholds for warmth, tactile and vibration detection (WDT, MDT and VDT) and exaggerated pain summation (WUR). After 3 months of unilateral L4-DRGSTIM all pain parameters exhibited trends towards normalization of sensitivity accumulating to a significant overall normalization for pain sensitivity (effect size: 0.91, p < 0.01), while with the one exception of WDT all non-nociceptive QST parameters remained unchanged. Overall change of non-nociceptive detection was negligible (effect size: 0.25, p > 0.40). Notably, reduction of pain summation (WUR) correlated significantly with pain reduction after 3 months of L4-DRGSTIM. Conclusions Selective L4-DRGSTIM lowered ongoing pain in CRPS patients and evoked significant normalization in the pain domain of the somatosensory profile. Thermoreception and mechanoreception remained unchanged. However, larger randomized, sham-controlled trials are highly warranted to shed more light on effects and mechanisms of dorsal root ganglion stimulation on quantitative sensory characteristics. The study protocol was registered at the 15.11.2016 on German Register for Clinical Trials (DRKS ID 00011267). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011267 |
| first_indexed | 2024-12-12T15:29:21Z |
| format | Article |
| id | doaj.art-a0485e7d2ac24d19bf2e9fad2fb811e7 |
| institution | Directory Open Access Journal |
| issn | 1479-5876 |
| language | English |
| last_indexed | 2024-12-12T15:29:21Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Translational Medicine |
| spelling | doaj.art-a0485e7d2ac24d19bf2e9fad2fb811e72022-12-22T00:20:10ZengBMCJournal of Translational Medicine1479-58762020-10-0118111410.1186/s12967-020-02566-8Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulationThomas Kinfe0Nico von Willebrand1Andreas Stadlbauer2Michael Buchfelder3Thomas L. Yearwood4Sajjad Muhammad5Shafqat R. Chaudhry6Sascha Gravius7Thomas Randau8Klemens Winder9Christian Maihöfner10Nadine Gravius11Walter Magerl12Division of Functional Neurosurgery and Stereotaxy, Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-NürnbergDepartment of Neurosurgery, Rheinische Friedrich-Wilhelms UniversityDepartment of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-NürnbergDepartment of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-NürnbergDepartment of Pain Management, Guy’s and St Thomas’ HospitalsDepartment of Neurosurgery, Heinrich-Heine University DüsseldorfDepartment of Basic Medical Sciences Shifa College of Pharmaceutical Sciences, Shifa Tameer-E-Millat UniversityDepartment of Orthopedics and Trauma Surgery, University Hospital Mannheim, University HeidelbergDepartment of Orthopedics and Trauma Surgery, Rheinische Friedrich-Wilhelms University BonnDepartment of Neurology, Friedrich-Alexander University (FAU) Erlangen-NürnbergDepartment of Neurology, Hospital FürthDepartment of Orthopedics and Trauma Surgery, University Hospital Mannheim, University HeidelbergInstitute of Neurophysiology, Medical Faculty Mannheim, University HeidelbergAbstract Background In a previous study, we reported that selective dorsal root ganglion stimulation (DRGSTIM) at DRG level L4 promoted a favorable outcome for complex regional pain syndrome (CRPS) patients along with DRGSTIM-related changes of inflammatory biomarkers in blood and saliva. The impact on somatosensation is largely unknown. Herein, we assessed the quantitative sensory profile to quantify L4-DRGSTIM effects in CRPS patients. Methods Twelve refractory CRPS patients (4 female; 8 male; mean age 69 ± 9 years) received standardized quantitative sensory testing (QST) protocol at baseline and after 3 months of unilateral L4-DRGSTIM assessing nociceptive and non-nociceptive thermal and mechanical sensitivity of the knee affected by CRPS and the contralateral non-painful knee area. Results At baseline, CRPS subjects showed significantly increased thresholds for warmth, tactile and vibration detection (WDT, MDT and VDT) and exaggerated pain summation (WUR). After 3 months of unilateral L4-DRGSTIM all pain parameters exhibited trends towards normalization of sensitivity accumulating to a significant overall normalization for pain sensitivity (effect size: 0.91, p < 0.01), while with the one exception of WDT all non-nociceptive QST parameters remained unchanged. Overall change of non-nociceptive detection was negligible (effect size: 0.25, p > 0.40). Notably, reduction of pain summation (WUR) correlated significantly with pain reduction after 3 months of L4-DRGSTIM. Conclusions Selective L4-DRGSTIM lowered ongoing pain in CRPS patients and evoked significant normalization in the pain domain of the somatosensory profile. Thermoreception and mechanoreception remained unchanged. However, larger randomized, sham-controlled trials are highly warranted to shed more light on effects and mechanisms of dorsal root ganglion stimulation on quantitative sensory characteristics. The study protocol was registered at the 15.11.2016 on German Register for Clinical Trials (DRKS ID 00011267). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011267http://link.springer.com/article/10.1186/s12967-020-02566-8Dorsal root ganglion stimulationComplex regional pain syndromeSensory quantitative testingObjective measures for neurostimulation |
| spellingShingle | Thomas Kinfe Nico von Willebrand Andreas Stadlbauer Michael Buchfelder Thomas L. Yearwood Sajjad Muhammad Shafqat R. Chaudhry Sascha Gravius Thomas Randau Klemens Winder Christian Maihöfner Nadine Gravius Walter Magerl Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation Journal of Translational Medicine Dorsal root ganglion stimulation Complex regional pain syndrome Sensory quantitative testing Objective measures for neurostimulation |
| title | Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation |
| title_full | Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation |
| title_fullStr | Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation |
| title_full_unstemmed | Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation |
| title_short | Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation |
| title_sort | quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral l4 dorsal root ganglion stimulation |
| topic | Dorsal root ganglion stimulation Complex regional pain syndrome Sensory quantitative testing Objective measures for neurostimulation |
| url | http://link.springer.com/article/10.1186/s12967-020-02566-8 |
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