An Resting-State Functional Magnetic Resonance Imaging Study Of Short-Term Spinal Cord Stimulation For Postherpetic Neuralgia

ObjectiveA before-after study in the same patient was conducted to observe the effect of short-term spinal cord stimulation(stSCS)in patients with postherpetic neuralgia(PHN),and to explore the central mechanism of stSCS modulated PHN combined with resting state functional magnetic resonance imaging(rs-fMRI)in regional homogeneity(ReHo)and degree centrality(DC).Subjects and MethodsFrom January 2021 to October 2021,10 patients with postherpetic neuralgia who underwent short-term spinal cord stimulation in the Department of Pain management of the First Affiliated Hospital of Zhengzhou University were selected,regardless of gender.Ten PHN patients underwent clinical parameters on pain numerical rating scale(NRS)scores,short-form McGill pain questionnaire Version-2(SF-MPQ-2),the pittsburgh sleep quality index(PSQI),hospital anxiety and depression scale(HADS),and an MRI protocol at baseline and after stSCS.Statistical analyses were performed using SPSS software(version 21.0).Wilcoxon signed rank tests were calculated to analyze differences in clinical outcomes between baseline and after stSCS.The significance level was set at 0.05.Paired t-tests were conducted with SPM8 in a whole-brain voxel wise manner for ReHo and DC comparisons between baseline and after stSCS.The significance levels of the voxel and cluster were p<0.005 and p<0.05 respectively.Correlations between the relative change in score on the questionnaires and the relative significant change in ReHo and DC values were calculated with non-parametric Spearman correlation tests.Results1.Compared with baseline,there was a significantly increased ReHo in the vast region of the left middle temporal gyrus,right superior frontal gyrus(SFG),precuneus,left supramarginal gyrus,left inferior parietal lobule(IPL),and right superior parietal gyrus.We also observed decreased ReHo in the right rolandic operculum and the right middle occipital gyrus after stSCS.2.Compared with baseline,there was a significantly increased DC in the vast region of the left middle temporal gyrus,right rolandic operculum,left supramarginal gyrus,right supramarginal gyrus,right precentral gyrus(PCG),left precuneus,left inferior parietal after stSCS.3.A significant positive correlation was found between ReHo changes in the right middle occipital gyrus and changes in intermittent pain(r=0.725,p=0.027).A significant negative correlation was identified between ReHo changes in the left precuneus and changes in intermittent pain(r=-0.673,p=0.047)and PSQI(r=-0.736,p=0.024)and left inferior parietal and affective descriptors(r=-0.746,p=0.021)and HADS-A(r=-0.782,p=0.013).4.A significant negative correlation was identified between DC changes in the left middle temporal gyrus(r=-0.690,p=0.040),right rolandic operculum(r=-0.742,p=0.022),right supramarginal gyrus(r=-0.845,p=0.004)and changes in intermittent pain,left precuneus and PSQI(r=-0.778,p=0.014),right rolandic operculum and HADS(r=-0.753,p=0.019)and HADS-D(r=-0.678,p=0.045),left inferior parietal(r=-0.686,p=0.041)and HADS-D.ConclusionThis study found that stSCS induced ReHo and DC changes in patients with PHN,thus suggesting that stSCS can change brain function to alleviate pain,sleep and emotional disorder.