Subthalamic deep brain stimulation modulates small fiber–dependent sensory thresholds in Parkinson’s disease

• Published in: Pain (Amsterdam) Vol. 153; no. 5; pp. 1107 - 1113
• Main Authors: Ciampi de Andrade, Daniel, Lefaucheur, Jean-Pascal, Galhardoni, Ricardo, Ferreira, Karine S.L., Brandão Paiva, Anderson Rodrigues, Bor-Seng-Shu, Edson, Alvarenga, Luciana, Myczkowski, Martin L., Marcolin, Marco Antonio, de Siqueira, Silvia R.D.T., Fonoff, Erich, Barbosa, Egberto Reis, Teixeira, Manoel Jacobsen
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier B.V 01-05-2012; Lippincott Williams & Wilkins, Inc; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Chronic pain; Deep Brain Stimulation; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Diseases of the nervous system; Female; Humans; Male; Medical sciences; Middle Aged; Nerve Fibers - physiology; Neurology; Pain - physiopathology; Pain Perception - physiology; Pain Threshold - physiology; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Parkinson’s disease; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sensory thresholds; Subthalamic nucleus; Subthalamic Nucleus - physiopathology; Subthalamic nucleus; Sensory thresholds; Deep brain stimulation; Chronic pain; Parkinson’s disease; Noxious stimulus; Parkinson's disease; Threshold detection; Central nervous system; Parkinson disease; Thermal sensitivity; Encephalon; Improvement; Pain; Degenerative disease; Ability; Human; Sensation; Pain sensitivity; Nervous system diseases; Stimulator; Cerebral disorder; Central nervous system disease; Detection threshold; Perception; Extrapyramidal syndrome
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.2012.02.016

Subthalamic nucleus deep brain stimulation contributes to relieve pain associated with Parkinson’s disease and specifically modulates small fiber–mediated sensations.
The effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms of Parkinson’s disease (PD) rarely have been investigated. Among these, sensory disturbances, including chronic pain (CP), are frequent in these patients. The aim of this study was to evaluate the changes induced by deep brain stimulation in the perception of sensory stimuli, either noxious or innocuous, mediated by small or large nerve fibers. Sensory detection and pain thresholds were assessed in 25 PD patients all in the off-medication condition with the stimulator turned on or off (on- and off-stimulation conditions, respectively). The relationship between the changes induced by surgery on quantitative sensory testing, spontaneous CP, and motor abilities were studied. Quantitative sensory test results obtained in PD patients were compared with those of age-matched healthy subjects. Chronic pain was present in 72% of patients before vs 36% after surgery (P=.019). Compared with healthy subjects, PD patients had an increased sensitivity to innocuous thermal stimuli and mechanical pain, but a reduced sensitivity to innocuous mechanical stimuli. In addition, they had an increased pain rating when painful thermal stimuli were applied, particularly in the off-stimulation condition. In the on-stimulation condition, there was an increased sensitivity to innocuous thermal stimuli but a reduced sensitivity to mechanical or thermal pain. Pain provoked by thermal stimuli was reduced when the stimulator was turned on. Motor improvement positively correlated with changes in warm detection and heat pain thresholds. Subthalamic nucleus deep brain stimulation contributes to relieve pain associated with PD and specifically modulates small fiber–mediated sensations.