Effects of deep brain stimulation and verbal suggestions on pain in Parkinson's disease

Sophie Rosenkjær; Victor Schwartz Hvingelby; Erik Lisbjerg Johnsen; Mette Møller; Elisa Carlino; Troels Staehelin Jensen; Lene Vase

doi:10.1515/sjpain-2023-0126

Effects of deep brain stimulation and verbal suggestions on pain in Parkinson's disease

Sophie Rosenkjær, Victor Schwartz Hvingelby^*, Erik Lisbjerg Johnsen, Mette Møller, Elisa Carlino, Troels Staehelin Jensen, Lene Vase

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

12 Downloads (Pure)

Abstract

Background and objectives ‒ In Parkinson’s disease (PD) patients, verbal suggestions have been shown to modulate motor and clinical outcomes in treatment with subthalamic deep brain stimulation (DBS). Furthermore, DBS may alleviate pain in PD. However, it is unknown if verbal suggestions influence DBS’ effects on pain. Methods ‒ Twenty-four people with PD and DBS had stimulation downregulated (80–60 to 20%) and upregulated (from 20–60 to 80%) in a blinded manner on randomized test days: (1) with negative and positive suggestions of pain for down- and upregulation, respectively, and (2) with no suggestions to effect (control). Effects of DBS and verbal suggestions were assessed on ongoing and evoked pain (hypertonic saline injections) via 0–10 numerical rating scales along with motor symptoms, expectations, and blinding. Results ‒ Stimulation did not influence ongoing and evoked pain but influenced motor symptoms in the expected direction. Baseline and experimental pain measures showed no patterns in degree of pain. There was a trend toward negative suggestions increasing pain and positive suggestions decreasing pain. Results show significant differences in identical stimulation with negative vs positive suggestions (60% conditions AUC 38.75 vs 23.32, t(13) = 3.10, p < 0.001). Expectations to pain had small to moderate effects on evoked pain. Patients estimated stimulation level correctly within 10 points Conclusion ‒ Stimulation does not seem to influence ongoing and evoked pain, but verbal suggestions may influence pain levels. Patients appear to be unblinded to stimulation level which is an important consideration for future studies testing DBS in an attempted blind fashion.

Original language	English
Article number	20230126
Journal	Scandinavian Journal of Pain
Volume	24
Issue	1
ISSN	1877-8860
DOIs	https://doi.org/10.1515/sjpain-2023-0126
Publication status	Published - 1 Jan 2024

Keywords

Deep Brain Stimulation/methods
Humans
Pain
Parkinson Disease/complications
Subthalamic Nucleus/physiology
placebo effect
pain
suggestion
Parkinson disease
deep brain stimulation

Access to Document

10.1515/sjpain-2023-0126Licence: CC BY

Effects of deep brain stimulation_Published_Version_2024Final published version, 6.94 MBLicence: CC BY

Cite this

@article{a3b7752764ed4d74b48d013be45f0ac4,

title = "Effects of deep brain stimulation and verbal suggestions on pain in Parkinson's disease",

abstract = "Background and objectives ‒ In Parkinson{\textquoteright}s disease (PD) patients, verbal suggestions have been shown to modulate motor and clinical outcomes in treatment with subthalamic deep brain stimulation (DBS). Furthermore, DBS may alleviate pain in PD. However, it is unknown if verbal suggestions influence DBS{\textquoteright} effects on pain. Methods ‒ Twenty-four people with PD and DBS had stimulation downregulated (80–60 to 20%) and upregulated (from 20–60 to 80%) in a blinded manner on randomized test days: (1) with negative and positive suggestions of pain for down- and upregulation, respectively, and (2) with no suggestions to effect (control). Effects of DBS and verbal suggestions were assessed on ongoing and evoked pain (hypertonic saline injections) via 0–10 numerical rating scales along with motor symptoms, expectations, and blinding. Results ‒ Stimulation did not influence ongoing and evoked pain but influenced motor symptoms in the expected direction. Baseline and experimental pain measures showed no patterns in degree of pain. There was a trend toward negative suggestions increasing pain and positive suggestions decreasing pain. Results show significant differences in identical stimulation with negative vs positive suggestions (60% conditions AUC 38.75 vs 23.32, t(13) = 3.10, p < 0.001). Expectations to pain had small to moderate effects on evoked pain. Patients estimated stimulation level correctly within 10 points Conclusion ‒ Stimulation does not seem to influence ongoing and evoked pain, but verbal suggestions may influence pain levels. Patients appear to be unblinded to stimulation level which is an important consideration for future studies testing DBS in an attempted blind fashion.",

keywords = "Deep Brain Stimulation/methods, Humans, Pain, Parkinson Disease/complications, Subthalamic Nucleus/physiology, placebo effect, pain, suggestion, Parkinson disease, deep brain stimulation",

author = "Sophie Rosenkj{\ae}r and Hvingelby, {Victor Schwartz} and Johnsen, {Erik Lisbjerg} and Mette M{\o}ller and Elisa Carlino and Jensen, {Troels Staehelin} and Lene Vase",

year = "2024",

month = jan,

day = "1",

doi = "10.1515/sjpain-2023-0126",

language = "English",

volume = "24",

journal = "Scandinavian Journal of Pain",

issn = "1877-8860",

publisher = "Walter de Gruyter GmbH",

number = "1",

}

Effects of deep brain stimulation and verbal suggestions on pain in Parkinson's disease. / Rosenkjær, Sophie; Hvingelby, Victor Schwartz ; Johnsen, Erik Lisbjerg et al.
In: Scandinavian Journal of Pain, Vol. 24, No. 1, 20230126, 01.01.2024.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Effects of deep brain stimulation and verbal suggestions on pain in Parkinson's disease

AU - Rosenkjær, Sophie

AU - Hvingelby, Victor Schwartz

AU - Johnsen, Erik Lisbjerg

AU - Møller, Mette

AU - Carlino, Elisa

AU - Jensen, Troels Staehelin

AU - Vase, Lene

PY - 2024/1/1

Y1 - 2024/1/1

N2 - Background and objectives ‒ In Parkinson’s disease (PD) patients, verbal suggestions have been shown to modulate motor and clinical outcomes in treatment with subthalamic deep brain stimulation (DBS). Furthermore, DBS may alleviate pain in PD. However, it is unknown if verbal suggestions influence DBS’ effects on pain. Methods ‒ Twenty-four people with PD and DBS had stimulation downregulated (80–60 to 20%) and upregulated (from 20–60 to 80%) in a blinded manner on randomized test days: (1) with negative and positive suggestions of pain for down- and upregulation, respectively, and (2) with no suggestions to effect (control). Effects of DBS and verbal suggestions were assessed on ongoing and evoked pain (hypertonic saline injections) via 0–10 numerical rating scales along with motor symptoms, expectations, and blinding. Results ‒ Stimulation did not influence ongoing and evoked pain but influenced motor symptoms in the expected direction. Baseline and experimental pain measures showed no patterns in degree of pain. There was a trend toward negative suggestions increasing pain and positive suggestions decreasing pain. Results show significant differences in identical stimulation with negative vs positive suggestions (60% conditions AUC 38.75 vs 23.32, t(13) = 3.10, p < 0.001). Expectations to pain had small to moderate effects on evoked pain. Patients estimated stimulation level correctly within 10 points Conclusion ‒ Stimulation does not seem to influence ongoing and evoked pain, but verbal suggestions may influence pain levels. Patients appear to be unblinded to stimulation level which is an important consideration for future studies testing DBS in an attempted blind fashion.

AB - Background and objectives ‒ In Parkinson’s disease (PD) patients, verbal suggestions have been shown to modulate motor and clinical outcomes in treatment with subthalamic deep brain stimulation (DBS). Furthermore, DBS may alleviate pain in PD. However, it is unknown if verbal suggestions influence DBS’ effects on pain. Methods ‒ Twenty-four people with PD and DBS had stimulation downregulated (80–60 to 20%) and upregulated (from 20–60 to 80%) in a blinded manner on randomized test days: (1) with negative and positive suggestions of pain for down- and upregulation, respectively, and (2) with no suggestions to effect (control). Effects of DBS and verbal suggestions were assessed on ongoing and evoked pain (hypertonic saline injections) via 0–10 numerical rating scales along with motor symptoms, expectations, and blinding. Results ‒ Stimulation did not influence ongoing and evoked pain but influenced motor symptoms in the expected direction. Baseline and experimental pain measures showed no patterns in degree of pain. There was a trend toward negative suggestions increasing pain and positive suggestions decreasing pain. Results show significant differences in identical stimulation with negative vs positive suggestions (60% conditions AUC 38.75 vs 23.32, t(13) = 3.10, p < 0.001). Expectations to pain had small to moderate effects on evoked pain. Patients estimated stimulation level correctly within 10 points Conclusion ‒ Stimulation does not seem to influence ongoing and evoked pain, but verbal suggestions may influence pain levels. Patients appear to be unblinded to stimulation level which is an important consideration for future studies testing DBS in an attempted blind fashion.

KW - Deep Brain Stimulation/methods

KW - Humans

KW - Pain

KW - Parkinson Disease/complications

KW - Subthalamic Nucleus/physiology

KW - placebo effect

KW - pain

KW - suggestion

KW - Parkinson disease

KW - deep brain stimulation

UR - http://www.scopus.com/inward/record.url?scp=85187968921&partnerID=8YFLogxK

U2 - 10.1515/sjpain-2023-0126

DO - 10.1515/sjpain-2023-0126

M3 - Journal article

C2 - 38485660

SN - 1877-8860

VL - 24

JO - Scandinavian Journal of Pain

JF - Scandinavian Journal of Pain

IS - 1

M1 - 20230126

ER -

Effects of deep brain stimulation and verbal suggestions on pain in Parkinson's disease

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this