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Journal of Translational Medicine
Published in: Journal of Translational Medicine 1/2020

01-12-2020 | Neuropathic Pain | Research

Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation

Authors: Thomas Kinfe, Nico von Willebrand, Andreas Stadlbauer, Michael Buchfelder, Thomas L. Yearwood, Sajjad Muhammad, Shafqat R. Chaudhry, Sascha Gravius, Thomas Randau, Klemens Winder, Christian Maihöfner, Nadine Gravius, Walter Magerl

Published in: Journal of Translational Medicine | Issue 1/2020

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Abstract

Background

In a previous study, we reported that selective dorsal root ganglion stimulation (DRGSTIM) at DRG level L4 promoted a favorable outcome for complex regional pain syndrome (CRPS) patients along with DRGSTIM-related changes of inflammatory biomarkers in blood and saliva. The impact on somatosensation is largely unknown. Herein, we assessed the quantitative sensory profile to quantify L4-DRGSTIM effects in CRPS patients.

Methods

Twelve refractory CRPS patients (4 female; 8 male; mean age 69 ± 9 years) received standardized quantitative sensory testing (QST) protocol at baseline and after 3 months of unilateral L4-DRGSTIM assessing nociceptive and non-nociceptive thermal and mechanical sensitivity of the knee affected by CRPS and the contralateral non-painful knee area.

Results

At baseline, CRPS subjects showed significantly increased thresholds for warmth, tactile and vibration detection (WDT, MDT and VDT) and exaggerated pain summation (WUR). After 3 months of unilateral L4-DRGSTIM all pain parameters exhibited trends towards normalization of sensitivity accumulating to a significant overall normalization for pain sensitivity (effect size: 0.91, p < 0.01), while with the one exception of WDT all non-nociceptive QST parameters remained unchanged. Overall change of non-nociceptive detection was negligible (effect size: 0.25, p > 0.40). Notably, reduction of pain summation (WUR) correlated significantly with pain reduction after 3 months of L4-DRGSTIM.

Conclusions

Selective L4-DRGSTIM lowered ongoing pain in CRPS patients and evoked significant normalization in the pain domain of the somatosensory profile. Thermoreception and mechanoreception remained unchanged. However, larger randomized, sham-controlled trials are highly warranted to shed more light on effects and mechanisms of dorsal root ganglion stimulation on quantitative sensory characteristics.
The study protocol was registered at the 15.11.2016 on German Register for Clinical Trials (DRKS ID 00011267).
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Metadata
Title
Quantitative sensory phenotyping in chronic neuropathic pain patients treated with unilateral L4-dorsal root ganglion stimulation
Authors
Thomas Kinfe
Nico von Willebrand
Andreas Stadlbauer
Michael Buchfelder
Thomas L. Yearwood
Sajjad Muhammad
Shafqat R. Chaudhry
Sascha Gravius
Thomas Randau
Klemens Winder
Christian Maihöfner
Nadine Gravius
Walter Magerl
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Journal of Translational Medicine / Issue 1/2020
Electronic ISSN: 1479-5876
DOI
https://doi.org/10.1186/s12967-020-02566-8

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