Investigation on Cerebrospinal Fluid Opioids and Neurotransmitters Related to Spinal Cord Stimulation

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Abstract
The purpose of this study was to assess the biochemical mechanisms underlying spinal cord stimulation (SCS). Seventeen patients with chronic pain were investigated by measuring cerebrospinal fluid concentrations of endogenous opioids and biogenic amines before and during dorsal column stimulation. BasaI cerebrospinal fluid β-endorphin levels were below the normal range. No significant change of norepinephrine, epinephrine, dopamine, β-endorphin, β-lipotropin, or adrenocorticotropic hormone levels were found after SCS. A 50% increase of cerebrospinal β-endorphin and β-lipotropin levels occurred in 6 out of 16 patients, namely those where SCS gave the major pain relief. These data confirm the derangement of the endogenous opioid system in chronic pain conditions and suggest that the β-endorphin response to SCS could have clinical value in predicting the success of treatment.