Spinal Cord Stimulation Associated with Neuropathic Pain Treatment

Estimulação de Medula Associada ao Tratamento da Dor Neuropática

• José Gabriel Abreu Moreira 1    
• Maria Clara Santana Lira 1    
• Heloisa Carneiro Brito 1    
• Guilherme Nobre Nogueira 2    
• Gustavo Rassier Isolan 3 4    
• Rafaela Fernandes Gonçalves 3 4    

• https://doi.org/10.22290/jbnc.2024.350308
• J Bras Neurocirur 35 (3):225-230, 2024

Resumo

A estimulação medular é um procedimento neurocirúrgico aprovado e utilizado para o tratamento de várias patologias, especialmente a dor neuropática. Esta revisão procura explicar os aspetos fisiológicos e anatômicos que envolvem essa terapia cirúrgica. Os fundamentos subjacentes aos aspetos analgésicos são desvendados: (i) inibição das vias ascendentes da dor; (ii) estimulação da produção de GABA; e (iii) estimulação dos recetores endocanabinoides. Além disso, fornecer insights que estimulem a compreensão de todos os seus aspetos e colocar questões para incentivar o estudo científico, considerando a presença de lacunas no conhecimento.

Palavras-chave

Estimulação medular; Neurocirurgia; GABA; Anatomia; Dor

Abstract

Spinal cord stimulation is a neurosurgical procedure approved and used for the treatment of various pathologies, especially neuropathic pain. This review seeks to explain the physiological and anatomical aspects surrounding this surgical therapy. The foundations underlying the analgesic aspects are unveiled: (i) inhibition of ascending pain pathways; (ii) stimulation of GABA production; and (iii) stimulation of endocannabinoid receptors. Furthermore, providing insights that stimulate understanding of all its aspects and posing questions to encourage scientific study, considering the presence of gaps in knowledge.

Keywords

Spinal cord stimulation; Neurosurgery; GABA; Anatomy; Pain

References

1. Huang B, Du XD, Fei Y, Lin HD, Deng H, Yao M. Pay attention to the clinical application of radiofrequency ablation in the treatment of neuropathic pain. Zhonghua Yi Xue Za Zhi. 2023;103(7):465-8. http:// doi.org/10.3760/cma.j.cn112137-20221111-02371. PMid:36800767.

2. Schestatsky P. Definition, diagnosis and treatment of neuropathic pain. Rev HCPA. 2008;28(3):177-87.

3. Bouchenaki H, Bégou M, Magy L, Hajj R, Demiot C. Les traitements pharmacologiques des douleurs neuropathiques [Pharmacological management of neuropathic pain]. Therapie. 2019;74(6):633-43. http:// doi.org/10.1016/j.therap.2019.04.003. PMid:31097329.

4. Yearwood TL. Neuropathic extremity pain and spinal cord stimulation. Pain Med. 2006;7(1, Suppl 1):S97-102. http://doi. org/10.1111/j.1526-4637.2006.00125.x.

5. Huang J, Gadotti VM, Chen L, et al. A neuronal circuit for activating descending modulation of neuropathic pain. Nat Neurosci. 2019;22(10):1659-68. http://doi.org/10.1038/s41593-019-0481-5. PMid:31501573.

6. De Groote S, Goudman L, Peeters R, et al. The influence of high dose spinal cord stimulation on the descending pain modulatory system in patients with failed back surgery syndrome. Neuroimage Clin. 2019;24:102087. http://doi.org/10.1016/j.nicl.2019.102087. PMid:31795057.

7. De Groote S, Goudman L, Peeters R, et al. Magnetic resonance imaging exploration of the human brain during 10 kHz spinal cord stimulation for failed back surgery syndrome: a resting-state functional magnetic resonance imaging study. Neuromodulation. 2020;23(1):46- 55. http://doi.org/10.1111/ner.12954. PMid:30974016.

8. Joosten EA, Franken G. Spinal cord stimulation in chronic neuropathic pain: mechanisms of action, new locations, new paradigms. Pain. 2020;161(1, Suppl 1):S104-13. http://doi.org/10.1097/j. pain.0000000000001854. PMid:33090743.

9. Song Z, Ultenius C, Meyerson BA, Linderoth B. Pain relief by spinal cord stimulation involves serotonergic mechanisms: an experimental study in a rat model of mononeuropathy. Pain. 2009;147(1-3):241-8. http://doi.org/10.1016/j.pain.2009.09.020. PMid:19836134.

10. Perruchoud C, Eldabe S, Batterham AM, et al. Analgesic efficacy of high-frequency spinal cord stimulation: a randomized double-blind placebo-controlled study. Neuromodulation. 2013;16(4):363-9. http:// doi.org/10.1111/ner.12027. PMid:23425338.

11. Chakravarthy S, Balasubramani PP, Mandali A, Jahanshahi M, Moustafa AA. The many facets of dopamine: toward an integrative theory of the role of dopamine in managing the body’s energy resources. Physiol Behav. 2018;195:128-41. http://doi.org/10.1016/j.physbeh.2018.06.032. PMid:30031088.

12. Song Z, Viisanen H, Meyerson BA, Pertovaara A, Linderoth B. Efficacy of kilohertz-frequency and conventional spinal cord stimulation in rat models of different pain conditions. Neuromodulation. 2014;17(3):226- 34. http://doi.org/10.1111/ner.12161. PMid:24612269.

13. De Ridder D, Plazier M, Kamerling N, Menovsky T, Vanneste S. Burst spinal cord stimulation for limb and back pain. World Neurosurg. 2013;80(5):642-649e1. http://doi.org/10.1016/j.wneu.2013.01.040. PMid:23321375.

14. Boyce-Rustay JM, Jarvis MF. Neuropathic pain: models and mechanisms. Curr Pharm Des. 2009;15(15):1711-6. http://doi. org/10.2174/138161209788186272. PMid:19442185.

15. Meuwissen KPV, van der Toorn A, Gu JW, Zhang TC, Dijkhuizen RM, Joosten EAJ. Active Recharge burst and tonic spinal cord stimulation engage different supraspinal mechanisms: a functional magnetic resonance imaging study in peripherally injured chronic neuropathic rats. Pain Pract. 2020;20(5):510-21. http://doi.org/10.1111/papr.12879. PMid:32124540.

16. Mekhail N, Deer TR, Kramer J, et al. Paresthesia-free dorsal root ganglion stimulation: an ACCURATE study sub-analysis. Neuromodulation. 2020;23(2):185-95. http://doi.org/10.1111/ner.12942. PMid:30861286.

17. Saadé NE, Tabet MS, Banna NR, Atweh SF, Jabbur SJ. Inhibition of nociceptive evoked activity in spinal neurons through a dorsal column-brainstem-spinal loop. Brain Res. 1985;339(1):115-8. http:// doi.org/10.1016/0006-8993(85)90627-4. PMid:4027608.

18. Song Z, Ansah OB, Meyerson BA, Pertovaara A, Linderoth B. The rostroventromedial medulla is engaged in the effects of spinal cord stimulation in a rodent model of neuropathic pain. Neuroscience. 2013;247:134-44. http://doi.org/10.1016/j.neuroscience.2013.05.027. PMid:23711584.

19. Sweet J, Badjatiya A, Tan D, Miller J. Paresthesia-free high-density spinal cord stimulation for post-laminectomy syndrome in a pre-screened population: a prospective case series. Neuromodulation. 2016;19(3):260-7. http://doi.org/10.1111/ner.12357. PMid:26481726.

---

1Universidade Federal da Paraíba – UFPB, João Pessoa, PB, Brasil.

2Universidade Federal do Ceará – UFC, Fortaleza, CE, Brasil.

3Centro Avançado de Neurologia e Neurocirurgia – CEANNE, Porto Alegre, RS, Brasil.

4Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brasil.

 

Received May 20, 2024

Accepted Jun 10, 2024