Effects of spinal cord stimulation on the flexor reflex and involvement of supraspinal mechanisms: an experimental study in mononeuropathic rats.

The physiological mechanisms responsible for pain relief caused by spinal cord stimulation (SCS) are essentially unknown and recent experimental data are sparse. In the present study the authors explored the possible involvement of supraspinal mechanisms in the effects of SCS applied in rats with experimental mononeuropathy produced by sciatic nerve ligation according to the method of Bennett and Xie or that of Seltzer, et al. Confirming results of a previous study undertaken by the authors, the thresholds of the early component of the flexor reflex (latency 8-12 msec), which is mediated by A fibers, were significantly lower in the nerve-ligated than in the intact leg. In halothane-anesthetized animals the spinal cord was exposed and SCS was applied with parameters similar to those used in clinical SCS. Ten minutes of SCS produced a significant elevation of the lowered threshold of the early flexor component only in the nerve-ligated leg, and this augmentatory effect of SCS persisted for 30 to 40 minutes after cessation of the stimulation. The threshold elevation amounted to between 50% and 80% of the prestimulatory value and it was related to the intensity of SCS. The threshold of the late, C-fiber-mediated component of the flexor reflex was not influenced in either of the legs. After transection of the spinal cord at the T-6 level, there was a moderate threshold increase in both the early and late components in both legs, but the threshold of the early component in the nerve-ligated leg remained lower. Spinal cord stimulation produced an almost identical threshold increase in the early component in the nerve-ligated leg with the same time course as before the transection. There was no effect on the late component of the reflex in either leg. The results indicate that this effect of SCS in mononeuropathic rats does not necessarily involve supraspinal mechanisms; instead SCS is operative at a spinal, segmental level. In view of the similarities between the effects of therapeutic SCS on cutaneous hypersensibility in patients with peripheral neuropathic pain and the effects demonstrated in neuropathic rats, the clinical pain relief achieved with SCS may be produced, at least partially, by intraspinal mechanisms.