title: Opioid peptide response to spinal cord stimulation in chronic critical limb ischemia.
abstract: Twelve patients with chronic critical limb ischemia in whom a spinal cord stimulation (SCS) system had been implanted for at least one year had increased microvascular flow and achieved healing of trophic acral lesions. After switching off the system, the clinical improvement persisted for 10 days and the neurohormonal pattern showed high plasma values of beta-endorphin and Met-enkephalin, normal dynorphin B, endothelin-1 and catecholamines, and low nitric oxide. Met-enkephalin levels were further increased (P < 0.01) immediately after switching on the electrical stimulation again. The persistence of high plasma opioid levels after switching off the spinal cord stimulation explains the absence of subjective complaints and suggests an involvement of opioids in the regulation and improvement of the microcirculation.
authors.affiliation: Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Ospedale S. Orsola, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Fontana
authors.forename: Pasquale
authors.initials: P
authors.lastname: Bernardi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Lanfranchi
authors.forename: Santi
authors.initials: S
authors.lastname: Spampinato
authors.forename: Rosanna
authors.initials: R
authors.lastname: Di Toro
authors.forename: Eleonora
authors.initials: E
authors.lastname: Conti
authors.forename: Francesca
authors.initials: F
authors.lastname: Bonafè
authors.forename: Sergio
authors.initials: S
authors.lastname: Coccheri
mesh_terms: D000328:Adult; D002395:Catecholamines / Q000097:blood; D004599:Electric Stimulation Therapy; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006801:Humans; D007511:Ischemia / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology*; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D018847:Opioid Peptides / Q000097:blood*; D013116:Spinal Cord; D034941:Upper Extremity / Q000098:blood supply / Q000473:pathology*
chemical_list: D002395:Catecholamines; D019332:Endothelin-1; D018847:Opioid Peptides; D009569:Nitric Oxide