Artikel
Restoration of laser evoked potentials (LEP) in patients recieving dorsal root ganglion (DRG) stimulation for chronic localized neuropathic pain
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Autoren
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Matthias H. Morgalla
- Clinic of Neurosurgery, University of Tuebingen, Tuebingen, Germany
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M. Fortunato de Barros Filho
- Clinic of Neurosurgery, University of Tuebingen, Tuebingen, Germany
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B. Subhash Chander
- Institute for Medical Psychology and Behaviour Neurobiology, University of Tuebingen, Tuebingen, Germany
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S. Soekadar
- Institute for Medical Psychology and Behaviour Neurobiology, University of Tuebingen, Tuebingen, Germany
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Marcos Tatagiba
- Clinic of Neurosurgery, University of Tuebingen, Tuebingen, Germany
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L. Garcia-Larrea
- Central Integration of Pain, Centre for Neuroscience of Lyon, Inserm, Lyon, France
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D. Ciampi de Andrade
- Neurology, University of São Paulo, São Paulo, Brazil
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Guilherme Lepski
- Clinic of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Chronic neuropathic pain is difficult to treat. Recently, a novel target for neuromodulation, the DRG, has been shown to be effective in managing neuropathic pain. However, the mechanisms underlying the impact of DRG stimulation are not well established. Therefore, we want to assess LEP’s for the quantification of the effects of DRG stimulation on pain processing.
Method: Patients implanted with a DRG stimulator (Spinal Modulation, Inc., Menlo Park, CA, USA) in order to manage chronic unilateral neuropathic pain of the groin or leg were enrolled in the study. LEP assessment was performed with DRG stimulation in ON and OFF phases. The measurements were performed immediately after DRG stimulator implantation (T0) and repeated after one month (T1) and six months (T2). Pain intensity was assessed by Numerical Rating Scale (NRS). The questionnaires PDI, BPI, NPSI, Pain-Detect and SF-36 were also evaluated. Quantitative sensory tests (QST) were also performed.
Results: We examined 5 patients prospectively (3 female, 2 male, mean age 47 years, age range 38-56 years). The major findings show a reduction in the mean pain from NRS 8.4 ± 0.48 to 2.4 ± 1.49 during DRG stimulation (OFF T0 vs. ON T2, p < 0.05, n = 5, U-Test). The LEP N2P2 amplitude was restored from 4.45 ± 3.64 (T0) to 10.96 ± 4.19 (T2) in 6 months (p < 0,05, n = 5, U-Test).
Conclusions: DRG stimulation is an effective method in order to relieve chronic localized neuropathic pain. Our data suggests that DRG stimulation can induce plastic changes in the pain pathways, restoring normal pain processing, thus causing pain reduction. Restoration of the LEP’s may also relate to a better clinical outcome.
