Article
Influence of BurstDRTM and tonic spinal cord stimulation (SCS) in chronic neuropathic pain on blood glucose levels
Der Einfluss von BurstDRTM und tonischer Rückenmarkstimulation (SCS) bei chronischen neuropathischen Schmerzen auf den Blutglukose-Spiegel
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Published: | June 26, 2020 |
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Objective: Spinal cord stimulation (SCS) has been successfully used to treat chronic neuropathic pain. Little is known about the effect of this stimulation on other body functions. It is conceivable that SCS influences glucose metabolism by stimulating vegetative neurons [1]. Especially the spatial proximity between stimulation electrodes and sympathetic neurons suggests a possible influence. In this study, we tested the hypothesis that SCS improves glucose metabolism and, specifically, insulin sensitivity.
Methods: Ten subjects (4 men, mean age 48.8 years) were studied who had an SCS system implanted to treat chronic neuropathic leg or arm pain. All participants had no manifest diabetes mellitus. To record the glucose metabolism and insulin sensitivity, the gold standard of the euglycemic hyperinsulinemic clamp (EHC) was used with an insulin infusion of 1mU / kg body weight per minute. During the clamp, sham-stimulation, tonic stimulation and BurstDRTM stimulation were performed randomly in each case for 30 min (n = 4) or 45 min (n = 6). The glucose infusion rate during the last 30 minutes of the stimulation and the insulin sensitivity index (glucose infusion divided by insulin levels) were determined.
Results: During the EHCs blood glucose was kept constant at 90 mg / dl. The required glucose infusion rate showed a tendency to a higher glucose infusion rate during tonic stimulation compared to sham stimulation (p = 0.047). If the glucose infusion rates were adjusted to the insulin level during the respective stimulation (insulin sensitivity index), there is a better insulin sensitivity under tonic stimulation than under sham stimulation (p = 0.037). Burst stimulation alone does not lead to a significantly better insulin sensitivity compared to sham. However, the mean effect of burst and tonic showed an improved insulin sensitivity compared to sham.
Conclusion: The results of this pilot study show that BurstDRTM and tonic stimulation improved glucose and insulin sensitivity. Thus, it can be supposed that in patients treated with SCS the sensitivity is generally altered by the stimulation. Further investigations are needed to investigate the clinical relevance for the improvement of glucose metabolism in diabetic patients and the underlying mechanisms.
References
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- Kapural L, Hayek SM, Stanton-Hicks M, Mekhail N. Decreased insulin requirements with spinal cord stimulation in a patient with diabetes. Anesth Analg. 2004 Mar;98(3):745-6. DOI: 10.1213/01.ane.0000102674.41527.1e