From Nerve to Brain: toward a Mechanistic Understanding of Spinal Cord Stimulation in Human Subjects

The fundamental hypothesis for this study is that spinal cord stimulators modulate theexcitability of primary afferent neurons to reduce pain, and that these changes can bedetected by measurement of axonal excitability. For the primary outcome, the studyinvestigators will leverage the sensitivity and reproducibility of threshold trackingnerve conduction studies to detect changes in the excitability of thickly myelinatednerve fibers. The study investigators will use microneurography to record directly fromprimary nociceptive afferents. Finally, the study investigators will perform plasmainflammatory cytokine profiles to measure changes due to spinal cord stimulators. Bycorrelating changes in outcome measurements with subject pain levels during therapeuticversus minimal spinal cord stimulators settings, this study will determine which effectsmay be mechanistically relevant and which are unrelated to reduction in pain. Thus, thisstudy will use robust, reproducible techniques to define the peripheral, central, andsystemic effects of spinal cord stimulators.