title: Burst Spinal Cord Stimulation Increases Peripheral Antineuroinflammatory Interleukin 10 Levels in Failed Back Surgery Syndrome Patients With Predominant Back Pain.
abstract: OBJECTIVE
  Burst spinal cord stimulation (SCS) has been reported to reduce back pain and improve functional capacity in Failed Back Surgery Syndrome (FBSS). However, its mechanism of action is not completely understood. Systemic circulating cytokines have been associated with the development of chronic back pain.
  
  
  METHODS
  This prospective, feasibility study enrolled 12 refractory FBSS patients with predominant back pain (70% of overall pain) suitable for Burst SCS. Back and leg pain intensity (back pain [VASB]/leg pain [VASL]), functional capacity (sleep quality [PSQI]), depressive symptoms (BDI), body weight, stimulation parameters, and plasma levels of pro-inflammatory (Il-1b; TNF; HMGB1)/anti-inflammatory (Il-10) cytokines were collected at baseline and after three months of Burst SCS and compared to healthy controls.
  
  
  RESULTS
  Pain intensity (pre VASB: 8.25 ± 0.75 vs. post 1.42 ± 1.24) and functional capacity (PSQI: pre 7.92 ± 3.92 vs. post 3.42 ± 1.24; BDI: pre 20.83 ± 3.56 vs. post 10.92 ± 0.75) significantly improved compared to baseline. Pro-inflammatory HMGB1 remained unchanged (preburst: 3.35 ± 3.25 vs. postburst: 3.78 ± 3.83 ng/mL; p = 0.27; W = -30) versus the HC group (2.53 ± 2.6 ng/mL; p = 0.47; U = 59), while anti-inflammatory IL-10 levels were significantly elevated after burst SCS as compared to baseline (preburst 12.54 ± 22.95 vs. postburst 43.16 ± 74.71 pg/mL; p = 0.03; W = -48) and HC group (HC: 7.03 ± 11.6 vs. postburst 43.16 ± 74.71 pg/mL; p = 0.03; W = -48; p = 0.04). Baseline preburst IL-10 values and preburst VASBsignificantly correlated (Spearman correlation r = -0.66; p = 0.05; 95 CI -0.86 to -0.24), while correlation was not significant between postburst IL-10 values and postburst VASB(Spearman correlation r = -0.49; p = 0.18; 95 CI -0.83 to -0.15). Postburst IL-10 values correlated significantly with postburst PSQI scores (Spearman correlation r = -0.66; p = 0.05; 95 CI -0.86 to -0.24), while no correlation was found between preburst and postburst changes related to the BDI.
  
  
  CONCLUSIONS
  Burst SCS increased systemic circulating anti-inflammatory IL-10, improved FBSS back pain and back pain associated co-morbidities like disrupted sleep architecture and depressive symptoms in FBSS patients. Thus, suggesting a possible relationship between burst SCS and burst-evoked modulation of peripheral anti-inflammatory cytokine IL-10 in chronic back pain.
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.|Division of Functional Neurosurgery and Neuromodulation, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kinfe
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Muhammad
authors.affiliation: Department of Anesthesiology, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.
authors.forename: Carolina
authors.initials: C
authors.lastname: Link
authors.affiliation: DZNE, German Center for Neurodegenerative Diseases, Bonn, Rheinische Friedrich Wilhelms University Hospital, Bonn, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Roeske
authors.affiliation: Department of Neurosurgery, Rheinische Friedrich Wilhelms - University Hospital, Bonn, Germany.
authors.forename: Shafqat R
authors.initials: SR
authors.lastname: Chaudhry
authors.affiliation: Comprehensive Pain and Rehabilitation, Pascagoula, MS, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Yearwood
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D055111:Failed Back Surgery Syndrome / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062187:Spinal Cord Stimulation / Q000379:methods*
chemical_list: D015415:Biomarkers; C508609:IL10 protein, human; D016753:Interleukin-10
keywords: Back pain; burst spinal cord stimulation; failed back surgery; neuroinflammation; objective biomarker