Neural predictors of therapeutic success of spinal cord stimulation in neuropathic pain patients

Spinal cord stimulation (SCS) for pain relief represents an effective palliative treatment in patients with intractable pain. Although cost-benefit analyses clearly favour SCS, a large number of patients with permanently implanted spinal cord stimulators show poor pain relief. To increase the success rate of SCS therapy and to identify factors which limit pain relief during SCS, we will conduct a prospective research study involving a set of electrophysiological and brain imaging experiments. The proposed research aims to identify the cerebral functional and structural predictors of long-term pain relief during SCS therapy, and the neurophysiological factors causing poor long-term outcomes in patients not responding to SCS. Our research will also address the role of neuronal plasticity in long-term effects of SCS by evaluating changes in grey matter density and brain volume across a one-year follow-up period. Functional aspects of pain relief during ongoing SCS will be investigated using electroencephalography (EEG) and behavioural experiments. The outcomes of this research will assist pain management teams in their decisions about suitability of SCS in a particular patient, and will identify the key neurophysiological factors preventing some patients from benefitting from SCS.