Research vision: Neuropathic Pain
Prof. Dr. B. Joosten, Neurobiologist
Research within this topic will be restricted to pain originating from and generated by central and peripheral neural structures. This defenition includes peripheral nerves spinal ganglia and rootss. Centrally gegenerated pain research will be restricted to spinal neuronal structures. The topics "Pain in Neonates and Children" and "Cancer Pain" are included in the research area "Neuropathic Pain" and will focus on the early development of the spinal modulating neuronal systems, the role of the NMDA-receptors, the central sensitisation phenomenon and their clinical implications.
Much experience has been build up with spinal cord stimulation (SCS) treatment in complex regional Pian Syndrom Type I (CRPS). The efficacy of SCS have been proven in CRPS Type I. The precise mode action of SCS is partially known. The same is true for SCS in the treatement of radiculpathies. Other indications for SCS such as small fiber polyneuropathy, spinal cord lesions, spinal myelopathy and neural plexus lesions have no evidence for efficacy. Besides, there is still no explanation for the phenomenon of responders and non-responders in the treatment with SCS.
A different development within interventional pain management is the use op pulsed radiofrequency (PRF). In contrast to radiofrequency (RF) treatment PRF has no neural interruption effect due to local heating. Although some effects have been shown at the level of the dorsal horn, the precise mechanism of PRF is completely obscure and has probably a central pain modulating mode of action. There is some evidence for efficacy of PRF in cervical radiculopathies. No evidence for efficacy exists in other indications of PRF treatment such as lumbar and thoracic radiculopathies, peripheral nerve lesions and neuropathies.
In general, the treatment of neuropathic pain in polyneuropathies and in particular diabetic polyneuropathy doesn't always show predictable therapeutic outcomes. Besides, it is still unclear why not all patients with diabetes develop a painful polyneuropathy. Gaps in the knowledge of the basal mechanisms of the development of polyneuropathy are probably the main reason. In cooperation with the department of internal medicine of the MUMC+ (Prof. Dr. N. Schaper) the efficacy of SCS in painful diabetic polyneuropathy will be evaluated.
Small fiber polyneuropathy is a separate entity within the polyneuropathies. Much experience is present in the department of neurology of the MUMC+ (Dr. K. Faber) with this disease. The aetiology, diagnosis and treatment of small fiber polyneuropathy (SFP) is largely unknown. There probably a aetiological role for the Na+- channels in SFP. Up till now the diagnosis of SFP is based on a combination of medical history, QST and nerve biopt, which show a decrease in the number of small nerve fibers. However, it is unclear why precisely a decrease of small nerve fibers is related to pain. Clinical research will focus on the treatment of SFP with SCS.