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

• Published in: Pain and therapy Vol. 13; no. 6; pp. 1645 - 1658
• Main Authors: Riera, Carolyn, de Oliveira, Daniela Souza, Borutta, Matthias, Regensburger, Martin, Zhao, Yining, Brenner, Steffen, Del Vecchio, Alessandro, Kinfe, Thomas M.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-12-2024; Adis, Springer Healthcare
• Subjects: Burst/tonic stimulation waveforms; Chronic pain; High-density surface electromyogram (HD-EMG); Internal Medicine; Medicine; Medicine & Public Health; Motor unit recruitment (MUR); Original Research; Pain Medicine; Spinal cord stimulation (SCS); Spinal cord stimulation (SCS); High-density surface electromyogram (HD-EMG); Burst/tonic stimulation waveforms; Motor unit recruitment (MUR); Chronic pain
• ISSN: 2193-8237; 2193-651X
• DOI: 10.1007/s40122-024-00670-x

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 (Chi
2
 = 1.933), 0.737 (Chi
2
 = 1.267), 0.706 (Chi
2
 = 1.4) and 0.586 (Chi
2
 = 1.933), respectively. The
p
values of the Friedman test at 30%MVT were 0.896 (Chi
2
 = 0.6), 0.583 (Chi
2
 = 1.95), 0.896 (Chi
2
 = 0.6) and 0.256 (Chi
2
 = 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.