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Spinal cord stimulation in experimental chronic painful diabetic polyneuropathy: Delayed effect of High‐frequency stimulation
Author(s) -
Beek M.,
Kleef M.,
Linderoth B.,
Kuijk S.M.J.,
Honig W.M.,
Joosten E.A.
Publication year - 2017
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.981
Subject(s) - stimulation , medicine , anesthesia , endocrinology , spinal cord , diabetes mellitus , psychiatry
Background Spinal cord stimulation ( SCS ) has been shown to provide pain relief in painful diabetic polyneuropathy ( PDPN ). As the vasculature system plays a great role in the pathophysiology of PDPN , a potential beneficial side‐effect of SCS is peripheral vasodilation, with high frequency ( HF ) SCS in particular. We hypothesize that HF ‐ SCS (500 Hz), compared with conventional ( CON ) or low frequency ( LF )‐ SCS will result in increased alleviation of mechanical hypersensitivity in chronic experimental PDPN . Methods Diabetes was induced in 8‐week‐old female Sprague–Dawley rats with an intraperitoneal injection of 65 mg/kg of streptozotocin ( n = 44). Rats with a significant decrease in mechanical withdrawal response to von Frey filaments over a period of 20 weeks were implanted with SCS electrodes ( n = 18). Rats were assigned to a cross‐over design with a random order of LF ‐, CON ‐, HF ‐ and sham SCS and mechanical withdrawal thresholds were assessed with von Frey testing. Results Compared with sham treatment, the average 50% WT score for 5 Hz was 4.88 g higher during stimulation ( p = 0.156), and 1.77 g higher post‐stimulation ( p = 0.008). CON ‐ SCS resulted in 50% WT scores 5.7 g, and 2.51 g higher during ( p = 0.064) and after stimulation ( p < 0.004), respectively. HF ‐ SCS started out with an average difference in 50% WT score compared with sham of 1.87 g during stimulation ( p = 0.279), and subsequently the steepest rise to a difference of 5.47 g post‐stimulation ( p < 0.001). Conclusions We demonstrated a delayed effect of HF ‐ SCS on mechanical hypersensitivity in chronic PDPN animals compared with LF ‐, or CON ‐ SCS . Significance This study evaluates the effect of SCS frequency (5–500 Hz) on mechanical hypersensitivity in the chronic phase of experimental PDPN . High frequency (500 Hz) – SCS resulted in a delayed effect‐ on pain‐related behavioural outcome in chronic PDPN .