The Effects of Spinal Cord Stimulation on Sleep, Quality of Life and Anxiety and Depressive Symptoms in Patients with Chronic Pain

Abstract

Objective: The aim of this study was to investigate whether spinal cord stimulation (SCS), a neuromodulation technique, causes any changes in sleep, quality of life, anxiety and depressive symptoms before and after the procedure in patients with chronic pain. Methods: The study was completed with 14 patients who were planned to undergo SCS for treatment-resistant chronic neuropathic pain and who applied to the psychiatry outpatient clinic for pre-treatment consultation. Patients were evaluated twice, before and 1 month after treatment. Patients were evaluated with LANNS Pain Scale, Hamilton Depression Scale (Ham-D), Hamilton Anxiety Scale (HAM-A), Pittzburg Sleep Quality Inventory (PUKI), and Quality of Life Scale Short Form (WHOQOL-Bref). Scale scores before and after the treatment were compared using a two-sample dependent t-test. Results: Depressive disorder was detected in 85.8% of the cases, anxiety disorder in 71.5%, and sleep disorder in 78.6%. The cases’ LANSS pain scale scores were 19.00±5.11 pre-treatment and 7.57±4.59 post-treatment, the difference being statistically significant (P=0.001). Significant differences were observed between pre- and post-test HAM-D, HAM-A, PSQI, quality of life (QoL) general health, QoL physical health, or QoL psychological health scores (P=.002, P=.014, P=.002, P=.002, P=.002, and P=.001, respectively). However, no significant differences were determined between pre- and post-test QoL social relationships or QoL environmental health scores (P=.160 and P=.831, respectively) Conclusion: Our data in this study suggest that SCS not only effectively reduces pain in treatment-resistant chronic pain, but also mediates significant improvements in sleep quality, anxiety and depressive states.

Keywords

• Chronic Pain
• Spinal Cord Stimulation
• Sleep
• Quality of Life
• Anxiety

Kronik Ağrılı Hastalarda Spinal Kord Stimülasyonu Uygulamasının Uyku, Yaşam Kalitesi, Anksiyete ve Depresif Semptomlar Üzerine Etkisi

Öz

Amaç: Bu çalışmanın amacı, bir nöromodülasyon tekniği olan omurilik stimülasyonunun (SCS) kronik ağrılı hastalarda işlem öncesi ve sonrasında uyku, yaşam kalitesi, anksiyete ve depresif belirtilerde herhangi bir değişikliğe neden olup olmadığını araştırmaktır. Yöntem: Çalışma, tedaviye dirençli kronik nöropatik ağrı nedeniyle SCS yapılması planlanan ve tedavi öncesi konsültasyon için psikiyatri polikliniğine başvuran 14 hasta ile tamamlandı. Hastalar tedaviden önce ve tedaviden 1 ay sonra olmak üzere iki kez değerlendirildi. Hastalar LANNS Ağrı Ölçeği, Hamilton Depresyon Ölçeği (Ham-D), Hamilton Anksiyete Ölçeği (HAM-A), Pittzburg Uyku Kalitesi Envanteri (PUKI), Yaşam Kalitesi Ölçeği Kısa Formu (WHOQOL-Bref) ile değerlendirildi. Tedavi öncesi ve tedavi sonrası ölçek puanları bağımlı iki örnekli t testi kullanılarak karşılaştırıldı. Bulgular: Olguların %85,8'inde depresif bozukluk, %71,5'inde anksiyete bozukluğu, %78,6'sında uyku bozukluğu saptandı. Olguların LANSS ağrı skalası skorları tedavi öncesi 19,00±5,11, tedavi sonrası 7,57±4,59 idi ve aradaki fark istatistiksel olarak anlamlıydı (P=,001). Ön test ve son test HAM-D, HAM-A, PUKİ, yaşam kalitesi (QoL), genel sağlık, QoL fiziksel sağlık veya QoL psikolojik sağlık puanları arasında anlamlı farklılıklar gözlendi (P=,002, P=,014, P= ,002, P=,002, P=,002 ve P=,001 sırasıyla). Ancak ön test ve son test QoL sosyal ilişkiler veya QoL çevre sağlığı puanları arasında anlamlı farklılık saptanmadı (sırasıyla P=,160 ve P=,831) Sonuç: Bu çalışmadaki verilerimiz, SCS'nin tedaviye dirençli kronik ağrıda sadece ağrıyı etkili bir şekilde azaltmakla kalmadığını, aynı zamanda uyku kalitesi, anksiyete ve depresif durumlarda da önemli iyileşmelere aracılık ettiğini göstermektedir.

Anahtar Kelimeler

• Kronik Ağrı
• Omurilik Stimülasyonu
• Uyku
• Yaşam Kalitesi
• Anksiyete

References

1. Uyar M, Köken İ. Kronik ağrı nörofizyolojisi. TOTBİD Der gisi. 2017;16(2). doi:10.14292/totbid.dergisi.2017.12.
2. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11(1). doi:10.1186/1471-2458-11-770
3. Moreno-Ligero M, Moral-Munoz JA, Salazar A, Failde I. mHealth Intervention for Improving Pain, Quality of Life, and Functional Disability in Patients With Chronic Pain: Systematic Review. JMIR Mhealth and Uhealth. 2023;11:e40844. doi:10.2196/40844
4. Grider JS, Manchikanti L, Carayannopoulos A, et al. Effectiveness of Spinal Cord Stimulation in Chronic Spinal Pain: A Systematic Review. Pain Physician. 2016;19(1):E33-E54.
5. Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2019;45(1):205-216. doi:10.1038/s41386-019-0439-z
6. Sribastav SS, Peiheng H, Jun L, et al. Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ. 2017;5:e3282. doi:10.7717/peerj.3282
7. Duenas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. Journal of Pain Research. 2016;Volume 9:457-467. doi:10.2147/jpr.s105892
8. Michaelides A, Zis P. Depression, anxiety and acute pain: links and management challenges. Postgraduate Medicine. 2019;131(7):438-444. doi:10.1080/00325481.2019.1663705

9. Lam CM, Latif U, Sack A, et al. Advances in Spinal Cord Stimulation. Bioengineering. 2023;10(2):185. doi:10.3390/bioengineering10020185
10. Deer TR, Mekhail N, Provenzano D, et al. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee. Neuromodulation. 2014;17(6):515-550. doi:10.1111/ner.12208
11. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92(1):147-157. doi:10.1016/s0304-3959(00)00482-6
12. Yucel A, Senocak M, Orhan EK, Cimen A, Ertas M. Results of the leeds assessment of neuropathic symptoms and signs pain scale in Turkey: A validation study. Journal of Pain. 2004;5(8):427-432. doi:10.1016/j.jpain.2004.07.001
13. Ağargün MY, Kara H, Anlar O. Pittsburgh Uyku Kalitesi İndeksi’nin geçerliği ve güvenirliği. Türk Psikiyatri Derg. 1996;7:107-11.
14. What quality of life? The WHOQOL Group. World Health Organization Quality of Life Assessment. World Health Forum. 1996;17(4):354-356.
15. Eser SY, Fidaner H, Fidaner C, et al. Yaşam kalitesinin ölçülmesi. WHOQOL-100 ve WHOQOOL-BREF”, 3P Dergisi. 1999;7(2):5-13.
16. Hamilton M. A Ratıng Scale For Depressıon. Journal of Neurology Neurosurgery & Psychiatry. 1960;23(1):56-62. doi:10.1136/jnnp.23.1.56
17. Akdemir A, Örsel S, Dağ İ, et al. Validity and reliability of Hamilton Depression Rating Scale (HDRS) and its use in clinic. J Psychiatry Psychology Psychopharmacology. 1996;4:251-259.
18. Hamilton M. The Assessment Of Anxıety States By Ratıng. British Journal of Medical Psychology. 1959;32(1):50-55. doi:10.1111/j.2044-8341.1959.tb00467.x
19. Yazıcı K, Demir B, Tanrıverdi N, et al. Hamilton anksiyete değerlendirme ölçeği, değerlendiriciler arası güvenirlik ve geçerlik çalışması. Türk Psikiyatri Derg. 1998;9:114-7.
20. Akbas M. Spinal cord stimulation in 62 patients: retrospective evaluation. Ağrı - the Journal of the Turkish Society of Algology. Published online January 1, 2016. doi:10.5505/agri.2016.08870.
21. Burke D, Lennon O, Fullen BM. Quality of life after spinal cord injury: The impact of pain. European Journal of Pain. 2018;22(9):1662-1672. doi:10.1002/ejp.1248
22. Williams L, Jones WJ, Shen J, Robinson RL, Weinberger M, Kroenke K. Prevalence and impact of depression and pain in neurology outpatients. Journal of Neurology Neurosurgery & Psychiatry. 2003;74(11):1587-1589. doi:10.1136/jnnp.74.11.1587
23. Sheng J, Liu S, Wang Y, Cui R, Zhang X. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plasticity. 2017;2017:1-10. doi:10.1155/2017/9724371
24. Corallo F, De Salvo S, Floridia D, et al. Assessment of spinal cord stimulation and radiofrequency. Medicine. 2020;99(3):e18633. doi:10.1097/md.0000000000018633
25. Patel SK, Gozal YM, Saleh MS, Gibson JL, Karsy M, Mandybur GT. Spinal cord stimulation failure: evaluation of factors underlying hardware explantation. Journal of Neurosurgery Spine. 2020;32(1):133-138. doi:10.3171/2019.6.spine181099
26. Leadley RM, Armstrong N, Reid KJ, Allen A, Misso KV, Kleijnen J. Healthy Aging in Relation to Chronic Pain and Quality of Life in Europe. Pain Practice. 2013;14(6):547-558. doi:10.1111/papr.12125
27. Josephson C, Keezer M, Wiebe S. Error in Figure. JAMA Neurology. 2022;79(4):420. doi:10.1001/jamaneurol.2022.0022
28. Kuo CC, Tsai ST, Huang XL, Chen YC. Potential benefits of spinal cord stimulation treatment on quality of life for paralyzed patients with spinal cord injury. Tzu Chi Medical Journal. 2023;35(2):131. doi:10.4103/tcmj.tcmj_102_22