Abstract
BackgroundBuilding on the recent finding that chronic pain patients with impaired functioning of the descending nociceptive inhibitory system (DNIS) present lower resting heart rate variability (HRV), this study aims to investigate the impact of Spinal Cord Stimulation (SCS) on HRV in patients with Failed Back Surgery Syndrome (FBSS). More precisely, we hypothesize that SCS influences the DNIS, with increased parasympathetic tone as a consequence, as measurable by HRV analysis.MethodsTwenty-two patients diagnosed with FBSS and treated with SCS participated in this study. HRV was measured with a 2-lead ECG registration tool during on and off states of SCS. HRV analysis for time, frequency, time-frequency and nonlinear domain parameters was based on a 5-minute recording segment.ResultsThe mean heart rate and low frequency power were significantly lower when SCS was activated. HRV, absolute and normalized high frequency power significantly increased during SCS compared to without SCS. The ratio of low frequency/high frequency ratios, as parameter for global sympathetic-parasympathetic equilibrium, significantly decreased when SCS was activated.ConclusionsWhen SCS is switched off, patients with FBSS present relatively stronger sympathetic tone and weaker parasympathetic activity. Activation of the SCS, possibly via stimulation of the DNIS, restores this disbalance of autonomic activity.
Highlights
It has previously been suggested that traditional, paresthesia-generating, Spinal Cord Stimulation (SCS) induces several changes in modulation circuits located in the cerebrum and brainstem
The authors declare no other conflicts of interests. This does not alter our Building on the recent finding that chronic pain patients with impaired functioning of the descending nociceptive inhibitory system (DNIS) present lower resting heart rate variability (HRV), this study aims to investigate the impact of Spinal Cord Stimulation (SCS) on HRV in patients with Failed Back Surgery Syndrome (FBSS)
HRV, absolute and normalized high frequency power significantly increased during SCS compared to without SCS
Summary
It has previously been suggested that traditional, paresthesia-generating, Spinal Cord Stimulation (SCS) induces several changes in modulation circuits located in the cerebrum and brainstem. Dysregulation of the ANS has been suggested in chronic pain patients with an overweight of sympathetic activation [16, 17]. This activation is denoted as a factor in pain maintenance and pain itself is a stressor that propagates sympathetic outflow [18]. Building on the recent finding that chronic pain patients with impaired functioning of the descending nociceptive inhibitory system (DNIS) present lower resting heart rate variability (HRV), this study aims to investigate the impact of Spinal Cord Stimulation (SCS) on HRV in patients with Failed Back Surgery Syndrome (FBSS). We hypothesize that SCS influences the DNIS, with increased parasympathetic tone as a consequence, as measurable by HRV analysis
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