Acute and long-term VNS effects on pain perception in a case of treatment-resistant depression.

Abstract:

:Vagus Nerve Stimulation (VNS) is approved by the FDA for treatment of both epilepsy and depression. Recent work has shown that VNS acutely affects pain perception in humans, actually increasing pain sensitivity momentarily while the device is firing. It is unclear how this acutely increased sensitivity might change over time with treatment and how it might relate to longer-term therapeutic effects of VNS on pain. We describe a patient with treatment-resistant depression and a history of severe lumbar degenerative disease with resultant chronic low back pain. His depression and pain symptoms both seemed to respond to VNS. He eventually stopped all medications and remained depression and pain free for 35 months with no change in his device settings. Sixty-six months after VNS implantation and 64 months after his initial clinical antidepressant response, under single-blind conditions, we performed quantitative sensory testing with laboratory thermal pain procedures during acute VNS-on and -off conditions. Interestingly, despite a significant and profound anti-nociceptive clinical response for the previous 35 months, he had significant increases in painfulness ratings while the VNS device was actively firing compared with device-off conditions. This case suggests that VNS-induced acute increases in pain sensitivity can coexist with a clinical anti-nociceptive response. If the acutely increased sensitivity sets the stage for the slower chronic anti-pain effects, the increased acute sensitivity does not disappear. Acute and chronic effects of VNS on pain perception merit further research.

journal_name

Neurocase

journal_title

Neurocase

authors

Borckardt JJ,Anderson B,Andrew Kozel F,Nahas Z,Richard Smith A,Jackson Thomas K,Kose S,George MS

doi

10.1080/13554790600788094

subject

Has Abstract

pub_date

2006-08-01 00:00:00

pages

216-20

issue

4

eissn

1355-4794

issn

1465-3656

pii

Q1774L3594640666

journal_volume

12

pub_type

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