title: Acute cardiovascular effects of epidural spinal cord stimulation.
abstract: BACKGROUND
  Several animal studies support the contention that thoracic spinal cord stimulation (SCS) might decrease arterial blood pressure.
  
  
  OBJECTIVE
  To determine if electrical stimulation of the dorsal spinal cord in humans will lower mean arterial pressure (MAP) and heart rate (HR).
  
  
  METHODS
  Case Series
  
  
  METHODS
  Ten normotensive subjects that were clinically indicated for SCS testing were studied. Two of the 10 patients who underwent testing were excluded from the analysis because they did not respond to the Cold Pressor Test (CPT). Systolic blood pressure, diastolic blood pressure, and heart rate were measured continuously at the wrist (using the Vasotrac device). SCS was administered with quadripolar leads implanted into the epidural space under fluoroscopic guidance. SCS was randomly performed either in the T1-T2 or T5-T6 region of the spinal cord during normal conditions as well as during transient stress induced by CPT. The CPT was conducted by immersing the non-dominant hand in ice-cold water for 2 minutes.
  
  
  RESULTS
  There were moderate decreases in MAP and HR during SCS at the T5-T6 region compared to baseline that did not reach statistical significance. However, SCS at the T1-T2 region tended to increase MAP and HR compared to baseline but the change did not reach statistical significance. Arterial blood pressure was transiently elevated by 9.4 +/- 3.8 mmHg using CPT during the control period with SCS turned off and also during SCS at either the T1-T2 region or T5-T6 region of the spinal cord (by 9.2 +/- 5 mmHg and 10.7 +/- 8.4 mmHg, respectively). During SCS at T5-T6, the CPT significantly increased MAP by 5.9+/-7.1 mmHg compared to control CPT (SCS off).
  
  
  CONCLUSIONS
  This study demonstrated that SCS at either the T1-T2 or T5-T6 region did not significantly alter MAP or HR compared to baseline (no SCS). However, during transcient stress (elevated sympathetic tone) induced by CPT, there was a significant increase in MAP and moderate decrease in HR during SCS at T5-T6 region, which is not consistent with previous data in the literature. Acute SCS did not result in adverse cardiovascular responses and proved to be safe.
authors: Medical Advanced Pain Specialists (MAPS), Minneapolis, MN 55433, USA. dschultz@painphysicians.com
authors: David M
authors: DM
authors: Schultz
authors: Shailesh
authors: S
authors: Musley
authors: Peggy
authors: P
authors: Beltrand
authors: Jill
authors: J
authors: Christensen
authors: Dave
authors: D
authors: Euler
authors: Eddy
authors: E
authors: Warman
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003080:Cold Temperature; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D013116:Spinal Cord; D013312:Stress, Physiological / Q000503:physiopathology*; D013904:Thoracic Vertebrae