title: Importance of Pharmacological Evaluation in the Treatment of Poststroke Pain by Spinal Cord Stimulation.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) is not typically recommended for the treatment of central poststroke pain (CPSP). We examined whether the pharmacological evaluation of CPSP is useful for selecting the candidates for SCS.
  
  
  METHODS
  Changes in visual analog scale (VAS) scores for pain following pharmacological evaluation using morphine, thiopental, and ketamine were compared with those following SCS in 22 CPSP patients.
  
  
  RESULTS
  Twelve of the 22 (54.5%) patients in the ketamine test and thiopental test, and 5 (22.7%) of the 22 patients in the morphine test showed a more than 40% reduction in VAS score and were judged as "sensitive." Pain relief by SCS was estimated as excellent (≧60% VAS score reduction) in three patients, good (30-59% reduction) in nine patients, and fair (10-29% reduction) in seven patients 24 months after the start of SCS. The remaining 3 patients evaluated as having poor pain relief (<10% reduction) only underwent test SCS. VAS score reduction induced by SCS was more significant in ketamine-sensitive patients than in ketamine-resistant patients during the test SCS (p < 0.01, Mann-Whitney's U test) and 24 months after the start of chronic SCS (p < 0.05). However, there were no significant differences in results for thiopental-sensitive/thiopental-resistant or morphine-sensitive/morphine-resistant patients during the test SCS and 24 months after chronic SCS. Analysis of the rate of VAS score reduction by pharmacological evaluation and SCS showed significant correlations with the results of the ketamine test (r = 0.670, p = 0.001, Pearson's correlation coefficient test), but not with those of the thiopental (r = 0.291, p = 0.231) or morphine test (r = 0.327, p = 0.175).
  
  
  CONCLUSIONS
  We speculate that the pharmacological evaluation of CPSP patients can be a useful tool for selecting candidates for SCS.
authors.affiliation: Division of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. yamamoto.takamitsu@nihon-u.ac.jp.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Division of Applied System Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Division of Applied System Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Obuchi
authors.affiliation: Division of Applied System Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kano
authors.affiliation: Division of Applied System Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Division of Applied System Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.affiliation: Division of Applied System Neuroscience, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Chikashi
authors.initials: C
authors.lastname: Fukaya
authors.affiliation: Division of Applied System Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yoshino
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis* / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement / Q000187:drug effects*; D012044:Regression Analysis; D062187:Spinal Cord Stimulation / Q000379:methods*; D020521:Stroke / Q000150:complications; D013874:Thiopental / Q000627:therapeutic use; D064232:Visual Analog Scale
chemical_list: D000700:Analgesics; D007649:Ketamine; D009020:Morphine; D013874:Thiopental
keywords: Chronic pain; neuropathic pain; neurostimulation; post-stroke; spinal cord stimulation