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작성일 2016-10-24 조회수 646
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(Medoc-TSA-2) Spinal cord stimulation attenuates temporal
Abstract
Evidence has shown that electrical stimulation at the dorsal columns attenuated the “wind-up” phenomenon in dorsal horn neurons in
nerve-injured rats. This study was aimed to test the effect of spinal cord stimulation (SCS) on temporal summation (TS), the clinical
correlate of the wind-up phenomenon in patients with radicular leg pain. Eighteen patients with SCS implants were tested both 30
minutes after SCS activation (“ON”) and 2 hours after turning it off (“OFF”), in a randomorder. Temporal summation was evaluated in the
most painful site in the affected leg and in the corresponding area in the contralateral leg by applying a tonic painful heat stimulus (46.5°C;
120 seconds) and simultaneous recording of the perceived heat pain intensity. Patients were also requested to report their clinical pain
intensity (0-100 numerical pain scale) during SCS “ON” and “OFF”. The Wilcoxon signed rank test was used in the comparisons between
SCS “ON” and “OFF”. Spinal cord stimulation activation significantly attenuated clinical pain intensity (from 66 6 18 to 27 6 31, P ,
0.001). In the nonpainful leg, SCS activation failed to produce an effect on TS (24620 vs 21624 in SCS “OFF” and “ON”, respectively; P
50.277). In contrast, a significant decrease in themagnitude of TS in the affected leg was observed in response to SCS activation (from
32633 to 19624; P50.017). These results suggest that attenuation of TS, which likely represents suppression of hyperexcitability in
spinal cord neurons, is a possible mechanism underlying SCS analgesia in patients with neuropathic pain.
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