Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T17:40:03.567Z Has data issue: false hasContentIssue false
  • English
  • Français

Spinal cord stimulation does not change peripheral skin blood flow in patients with neuropathic pain

Published online by Cambridge University Press:  11 July 2005

M. Ather ,
P. Di Vadi ,
D. Light ,
J. R. Wedley  and
W. C. Hamann
M. Ather
Affiliation:
Guy's and St Thomas' Hospital, Pain Management Unit, London, UK
P. Di Vadi
Affiliation:
University Hospital Lewisham, Department of Anaesthetics and Pain Management, London, UK
D. Light
Affiliation:
Guy's and St Thomas' Hospital, Pain Management Unit, London, UK
J. R. Wedley
Affiliation:
Guy's and St Thomas' Hospital, Pain Management Unit, London, UK
W. C. Hamann
Affiliation:
Guy's and St Thomas' Hospital, Pain Management Unit, London, UK University Hospital Lewisham, Department of Anaesthetics and Pain Management, London, UK
Get access

Extract

Summary

Background and objective: Spinal cord stimulation has been used successfully for many years in the management of neuropathic pain. Nociceptive pathways are closely integrated into many autonomic reflexes. The aim was to test the hypothesis that pain relief caused by spinal cord stimulation is related to changes in peripheral skin blood flow.

Methods: Twelve patients with spinal cord stimulators implanted as a treatment for neuropathic pain were entered into the study. Laser Doppler perfusion scanning was used as a direct method for selective measurement of changes in skin (peripheral) blood flow. Measurements were taken before and after the onset of spinal cord stimulation over the site of its sensory projection. The degree of pain relief due to spinal cord stimulation and the skin temperature of each patient were also recorded.

Results: Apart from one patient, spinal cord stimulation did not change skin blood flow in a statistically significant manner.

Conclusions: Pain relief due to spinal cord stimulation is not related to changes of skin blood flow.

Keywords

INVESTIGATIVE TECHNIQUES, laser Doppler flowmetry, rheologyNEUROLOGICAL MANIFESTATIONS, painPHYSICAL STIMULATION, electric stimulation, spinal cord
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 9 , September 2003 , pp. 736 - 739
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971–979.Google Scholar
Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 1967; 46: 489–491.Google Scholar
Broseta J, Barbera J, de Vera JA, et al. Spinal cord stimulation in peripheral arterial disease. J Neurosurg 1986; 64: 71–80.Google Scholar
De la Porte, van de Kelft E. Spinal cord stimulation in failed back surgery syndrome. Pain 1993; 52: 55–61.Google Scholar
Krainick JU, Thoden U, Riechert T. Pain reduction in amputees by long term spinal cord stimulation. Long-term follow up study over 5 years. J Neurosurg 1980; 52: 346–350.Google Scholar
Kumar K, Toth C, Nath RK. Spinal cord stimulation is effective in reflex sympathetic dystrophy. Neurosurgery 1997; 40: 503–509.Google Scholar
Kemler MA, Barendse GA, van Kleef M, et al. Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000; 343: 618–624.Google Scholar
Kumar K, Toth C, Nath RK, Laing P. Epidural spinal cord stimulation for treatment of chronic pain: some predictors of success. A 15-year experience. Surg Neurol 1998; 50: 110–121.Google Scholar
North RB, Kidd DH, Zahurak M, James CS, Long DM. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 1993; 32: 384–394.Google Scholar
McLachlan EM, Janig W, Devor M, Michaelis M. Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature 1993; 363: 543–546.Google Scholar
Jacobs MJ, Jorning PJG, Joshi SR, Kitslaar PJ, Slaaf DW, Reneman RS. Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischaemia. Ann Surg 1988; 207: 179–183.Google Scholar
Claeys LGY. Improvement of microcirculatory blood flow under epidural spinal cord stimulation in patients with nonreconstructible peripheral arterial occlusive disease. Artif Organs 1997; 21: 202–205.Google Scholar
Kumar K, Toth C, Nath RK, Verma AK, Burgess JJ. Improvement of limb circulation in peripheral vascular disease using epidural spinal cord stimulation: a prospective study. J Neurosurg 1997; 86: 662–669.Google Scholar
Klomp HM, Spincemaille GH, Steyerberg EW, Habbema JD, van Urk H. Spinal cord stimulation in critical limb ischaemia: a randomised trial, ESES Study Group. Lancet 1999; 353: 1040–1041.Google Scholar
Ghajar AW, Miles JB. The differential effect of the level of spinal cord stimulation on patients with advanced peripheral vascular disease in the lower limbs. Br J Neurosurg 1998; 12: 402–408.Google Scholar
Essex TJH, Byrne PO. A laser Doppler scanner for imaging blood flow in skin. J Biomed Engl 1991; 13: 189–194.Google Scholar
Everitt BS. Analysis of longitudinal data. Beyond MANOVA. Br J Psych 1998; 172: 7–10.Google Scholar
Geisser S, Greenhouse S. An extension of Box's results on the use of the F distribution in multivariate analysis. Ann Math Stat 1958; 29: 885–891.Google Scholar
McCance AJ, Thompson PA, Forfar JC. Increased cardiac sympathetic nervous activity in patients with unstable coronary heart disease. Eur Heart J 1993; 14: 751–757.Google Scholar
Devulder J, Duprez D, De Laat M, Rolly G. Epidural spinal cord stimulation does not improve microvascular blood flow in neuropathic pain. Angiology 1996; 47: 1145–1149.Google Scholar
Kemler MA, Barendse GA, van Kleef M, Egbrink MG. Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation. Anesthesiology 2000; 92: 1653–1660.Google Scholar