title: Spinal cord stimulation modulates cerebral function: an fMRI study.
abstract: BACKGROUND
  Although spinal cord stimulation (SCS) is widely used for chronic neuropathic pain after failed spinal surgery, little is known about the underlying physiological mechanisms. This study aims to investigate the neural substrate underlying short-term (30 s) SCS by means of functional magnetic resonance imaging in 20 patients with failed back surgery syndrome (FBSS).
  
  
  METHODS
  Twenty patients with FBSS, treated with externalized SCS, participated in a blocked functional magnetic resonance imaging design with stimulation and rest phases of 30 s each, repeated eight times in a row. During scanning, patients rated pain intensity over time using an 11-point numerical rating scale with verbal anchors (0 = no pain at all to 10 = worst pain imaginable) by pushing buttons (left hand, lesser pain; right hand, more pain). This scale was back projected to the patients on a flat screen allowing them to manually direct the pain indicator. To increase the signal-to-noise ratio, the 8-min block measurements were repeated three times.
  
  
  RESULTS
  Marked deactivation of the bilateral medial thalamus and its connections to the rostral and caudal cingulate cortex and the insula was found; the study also showed immediate pain relief obtained by short-term SCS correlated negatively with activity in the inferior olivary nucleus, the cerebellum, and the rostral anterior cingulate cortex.
  
  
  CONCLUSIONS
  Results indicate the key role of the medial thalamus as a mediator and the involvement of a corticocerebellar network implicating the modulation and regulation of averse and negative affect related to pain. The observation of a deactivation of the ipsilateral antero-medial thalamus might be used as a region of interest for further response SCS studies.
authors.affiliation: Department of Neurosurgery and Center for Neuroscience, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. mtmoens@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Moens
authors.forename: S
authors.initials: S
authors.lastname: Sunaert
authors.forename: P
authors.initials: P
authors.lastname: Mariën
authors.forename: R
authors.initials: R
authors.lastname: Brouns
authors.forename: A
authors.initials: A
authors.lastname: De Smedt
authors.forename: S
authors.initials: S
authors.lastname: Droogmans
authors.forename: P
authors.initials: P
authors.lastname: Van Schuerbeek
authors.forename: R
authors.initials: R
authors.lastname: Peeters
authors.forename: J
authors.initials: J
authors.lastname: Poelaert
authors.forename: B
authors.initials: B
authors.lastname: Nuttin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004599:Electric Stimulation Therapy / Q000379:methods*; D055111:Failed Back Surgery Syndrome / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology* / Q000628:therapy*; D010147:Pain Measurement; D019047:Phantoms, Imaging; D013116:Spinal Cord / Q000503:physiopathology*; D016896:Treatment Outcome