Brain activity modifications following spinal cord stimulation for chronic neuropathic pain: a systematic review

Lisa Bentley, Rui Duarte, Paul Furlong, Robert L Ashford, Jon H Raphael

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    30 Citations (Scopus)
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    Abstract

    Background and objective: Spinal Cord Stimulation is believed to exert supraspinal effects; however these mechanisms are still far from fully elucidated. This systematic review aims to assess existing neurophysiological and functional neuroimaging literature to reveal current knowledge regarding the effects of SCS for chronic neuropathic pain on brain activity, to identify gaps in knowledge, and to suggest directions for future research.
    Databases and data treatment: Electronic databases and hand-search of reference lists were employed to identify publications investigating brain activity associated with SCS in patients with chronic neuropathic pain, using neurophysiological and functional neuroimaging techniques (fMRI, PET, MEG, EEG). Studies investigating patients with SCS for chronic neuropathic pain and studying brain activity related to SCS were included. Demographic data (age, gender), study factors (imaging modality, patient diagnoses, pain area, duration of SCS at recording, stimulus used) and brain areas activated were extracted from the included studies.
    Results: Twenty-four studies were included. Thirteen studies used neuroelectrical imaging techniques, eight studies used haemodynamic imaging techniques, two studies employed both neuroelectrical and haemodynamic techniques separately, and one study investigated cerebral neurobiology.
    Conclusions: The limited available evidence regarding supraspinal mechanisms of SCS does not allow us to develop any conclusive theories. However, the studies included appear to show an inhibitory effect of SCS on somatosensory evoked potentials, as well as identifying the thalamus and anterior cingulate cortex as potential mediators of the pain experience. The lack of substantial evidence in this area highlights the need for large scale controlled studies of this kind.
    Original languageEnglish
    Pages (from-to)499-511
    JournalEuropean Journal of Pain
    Volume20
    Issue number4
    Early online date1 Oct 2015
    DOIs
    Publication statusPublished - Apr 2016

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