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

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Abstract

Background and objective: Spinal cord stimulation (SCS) 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.

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  • Brain activity modifications following spinal cord stimulation for chronic neuropathic pain

    Rights statement: This is the peer reviewed version of the following article: Bentley, L. D., Duarte, R. V., Furlong, P. L., Ashford, R. L., & Raphael, J. H. (2015). Brain activity modifications following spinal cord stimulation for chronic neuropathic pain: a systematic review. European journal of pain, Early view, which has been published in final form at http://dx.doi.org/10.1002/ejp.782. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

    Accepted author manuscript, 678 KB, PDF-document

Details

Original languageEnglish
Pages (from-to)499-511
Number of pages13
JournalEuropean Journal of Pain
Volume20
Issue number4
Early online date1 Oct 2015
DOIs
Publication statusPublished - Apr 2016

Bibliographic note

This is the peer reviewed version of the following article: Bentley, L. D., Duarte, R. V., Furlong, P. L., Ashford, R. L., & Raphael, J. H. (2015). Brain activity modifications following spinal cord stimulation for chronic neuropathic pain: a systematic review. European journal of pain, Early view, which has been published in final form at http://dx.doi.org/10.1002/ejp.782. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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