Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients

Carolyn Riera; Daniela Souza de Oliveira; Matthias Borutta; Martin Regensburger; Yining Zhao; Steffen Brenner; Alessandro Del Vecchio; Thomas M Kinfe

doi:10.1007/s40122-024-00670-x

Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients

Pain Ther. 2024 Dec;13(6):1645-1658. doi: 10.1007/s40122-024-00670-x. Epub 2024 Oct 18.

Authors

Affiliations

¹ Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
² Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
³ Department of Neurology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
⁴ Mannheim Center for Neuromodulation and Neuroprosthetics (MCNN), Department of Neurosurgery, Medical Faculty Mannheim, Ruprechts-Karl-University Heidelberg, Mannheim, Germany.
⁵ Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany. thomasmehari.kinfe@medma.uni-heidelberg.de.
⁶ Department of Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany. thomasmehari.kinfe@medma.uni-heidelberg.de.
⁷ Mannheim Center for Neuromodulation and Neuroprosthetics (MCNN), Department of Neurosurgery, Medical Faculty Mannheim, Ruprechts-Karl-University Heidelberg, Mannheim, Germany. thomasmehari.kinfe@medma.uni-heidelberg.de.

^# Contributed equally.

Abstract

Introduction: Spinal cord stimulation (SCS) represents an established interventional pain therapeutic; however, the SCS effects of SCS waveforms on motor neuron recruitment of the lower limbs of chronic pain patients remain largely unknown.

Methods: We investigated these effects by performing isometric ankle-dorsal flexions at varying force levels under four SCS conditions: SCS Off (1 week), burst SCS (40 Hz), SCS Off (acute), and tonic SCS (130 Hz). Muscle activity was recorded via high-density surface electromyography (64-electrode grid) on the tibialis anterior muscle. Motor unit action (MUs) potentials were analyzed for recruitment and de-recruitment thresholds, discharge rate, inter-spike interval, and common synaptic input.

Results: In this prospective study, we included nine patients (five females; four males; mean age 59 years) with chronic pain treated with thoracic (Th7-Th8) epidural spinal stimulation. A total of 97 MUs were found for 15% maximal voluntary torque (MVT) and 83 for 30%MVT, an average of 10.8 ± 3.7 for 15%MVT and 10.4 ± 3.5 for 30%MVT. While a few subject-specific variations were observed, our study suggests that the different SCS frequencies applied do not significantly influence motor unit discharge characteristics in the TA muscle among the participants (p values at 15%MVT were 0.586 (Chi² = 1.933), 0.737 (Chi² = 1.267), 0.706 (Chi² = 1.4) and 0.586 (Chi² = 1.933), respectively. The p values of the Friedman test at 30%MVT were 0.896 (Chi² = 0.6), 0.583 (Chi² = 1.95), 0.896 (Chi² = 0.6) and 0.256 (Chi² = 4.05). No significant difference was found for the different stimulation types for the delta (0-5 Hz), alpha (5-12 Hz), and beta (15-30 Hz) bands at both force levels.

Conclusions: In summary, we did not observe any changes in motor unit oscillatory activity at any low and high bandwidths, indicating that SCS using different waveforms (tonic/burst) does not significantly influence motor neuron recruitment for non-motor individuals with chronic pain.

Keywords: Burst/tonic stimulation waveforms; Chronic pain; High-density surface electromyogram (HD-EMG); Motor unit recruitment (MUR); Spinal cord stimulation (SCS).