Epidural spinal cord stimulation for neuropathic pain reduces blood pressure in patients with hypertension independent of pain relief: A retrospective study

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution Surgut Clinical Trauma Hospital. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome). Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the Pain Detect questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation. Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements. Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

Download Full-text

Epidural Spinal Cord Stimulation for Neuropathic Pain: Algology Unit in Bagcilar Training and Research Hospital Data Collection and Analysis

Spine Research ◽

10.21767/2471-8173.100017 ◽

2016 ◽

Vol 02 (02) ◽

Author(s):

Abdulkadir YektaA

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Data Collection ◽

Spinal Cord Stimulation ◽

Hospital Data ◽

Research Hospital ◽

Data Collection And Analysis ◽

Epidural Spinal Cord Stimulation ◽

Training And Research

Download Full-text

Epidural Spinal Cord Stimulation of Lumbosacral Networks Modulates Arterial Blood Pressure in Individuals With Spinal Cord Injury-Induced Cardiovascular Deficits

Frontiers in Physiology ◽

10.3389/fphys.2018.00565 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 23

Author(s):

Sevda C. Aslan ◽

Bonnie E. Legg Ditterline ◽

Michael C. Park ◽

Claudia A. Angeli ◽

Enrico Rejc ◽

...

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Arterial Blood Pressure ◽

Spinal Cord Stimulation ◽

Arterial Blood ◽

Cord Injury ◽

Epidural Spinal Cord Stimulation ◽

Stimulation Of

Download Full-text

Spinal Cord Stimulation for Neuropathic Pain: Current Trends and Future Applications

Brain Sciences ◽

10.3390/brainsci8080138 ◽

2018 ◽

Vol 8 (8) ◽

pp. 138 ◽

Cited By ~ 19

Author(s):

Ivano Dones ◽

Vincenzo Levi

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

Therapeutic Option ◽

Neural Pathways ◽

Chronic Neuropathic Pain ◽

Pain Medications ◽

Epidural Spinal Cord Stimulation ◽

Pain Therapists ◽

Effective Drugs

The origin and the neural pathways involved in chronic neuropathic pain are still not extensively understood. For this reason, despite the wide variety of pain medications available on the market, neuropathic pain is challenging to treat. The present therapeutic alternative considered as the gold standard for many kinds of chronic neuropathic pain is epidural spinal cord stimulation (SCS). Despite its proved efficacy, the favourable cost-effectiveness when compared to the long-term use of poorly effective drugs and the expanding array of indications and technical improvements, SCS is still worldwide largely neglected by general practitioners, neurologists, neurosurgeons and pain therapists, often bringing to a large delay in considering as a therapeutic option for patients affected by neuropathic chronic pain. The present state of the art of SCS in the treatment of chronic neuropathic pain is here overviewed and speculations on whether to use a trial period or direct implant, to choose between percutaneous leads or paddle electrodes and on the pros and cons of the different patterns of stimulation presently available on the market (tonic stim, high-frequency stim and burst stim) are described.

Download Full-text

Intrathecal Clonidine and Baclofen Enhance the Pain-Relieving Effect of Spinal Cord Stimulation

Neurosurgery ◽

10.1227/01.neu.0000370249.41634.4f ◽

2010 ◽

Vol 67 (1) ◽

pp. 173-181 ◽

Cited By ~ 40

Author(s):

Gastón Schechtmann ◽

Göran Lind ◽

Jaleh Winter ◽

Björn A. Meyerson ◽

Bengt Linderoth

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Animal Experiments ◽

Pain Reduction ◽

Saline Control ◽

Similar Data ◽

Intrathecal Clonidine

Abstract OBJECTIVE Spinal cord stimulation (SCS) is a well-established treatment for neuropathic pain; nevertheless, 40% of patients fail to obtain satisfactory pain relief and in many patients, the effect tends to diminish with time. Based on animal experiments, intrathecal baclofen was previously introduced clinically to enhance suboptimal SCS effects. Later animal experiments demonstrated similar data for clonidine. The aim of this study was to elucidate whether intrathecal clonidine or baclofen enhances the effect of SCS in neuropathic pain patients in whom the pain relieving-effect of SCS is inadequate. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted with 10 patients experiencing neuropathic pain with insufficient pain relief with SCS alone. Clonidine, baclofen, and saline (control) were intrathecally administered by bolus injections in combination with SCS. RESULTS Seven of 10 patients reported significant pain reduction when SCS was combined with active drugs. The mean visual analog scale ratings were reduced by more than 50% with either drug combined with SCS. Four patients previously treated with SCS alone later underwent implantation of a pump for long-term administration of clonidine or baclofen. In the 2 patients with clonidine pumps with a mean follow-up of 15 months, the combined therapy produced pain reduction of 55% and 45%, respectively. The corresponding effect with baclofen was 32% and 82%, respectively, at 7 months follow-up. CONCLUSION A trial with clonidine and baclofen combined with SCS may be warranted in patients who do not obtain satisfactory pain relief with SCS alone or experienced a decreasing therapeutic effect.

Download Full-text

Spinal cord stimulation of dorsal columns in a rat model of neuropathic pain: Evidence for a segmental spinal mechanism of pain relief

Pain ◽

10.1016/j.pain.2011.10.015 ◽

2012 ◽

Vol 153 (1) ◽

pp. 177-183 ◽

Cited By ~ 36

Author(s):

H. Smits ◽

M. van Kleef ◽

E. A. Joosten

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Pain Relief ◽

Rat Model ◽

Spinal Cord Stimulation ◽

Spinal Mechanism ◽

Dorsal Columns ◽

Stimulation Of

Download Full-text

Spinal Cord Stimulation for Chronic Refractory Neuropathic Pain: A Technical Note Initial Experience of Two cases

Indian Journal of Neurosurgery ◽

10.1055/s-0040-1716934 ◽

2021 ◽

Author(s):

Sanjeev Srivastava ◽

Pawan Goyal ◽

Anurag Sharma ◽

Sanjay K. Rajan ◽

Aditya Gupta

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Pulse Generator ◽

Technical Note ◽

Current Evidence ◽

Chronic Neuropathic Pain ◽

Thoracic Spinal Cord ◽

Dorsal Aspect

AbstractSpinal cord stimulation is an established procedure for relieving chronic neuropathic pain conditions. Although it has been over five decades since the first spinal cord stimulation (SCS) was developed, it has only been used in a few cases in India. It is primarily based on the “Gate Theory” of pain. The mechanism of its action is not exactly clear, but reports have suggested that it plays the main role in selectively stimulating the large diameter pain fibers in the dorsal aspect of spinal cord. SCS procedure involves a very careful case selection, and current evidence suggests that only a few conditions of chronic refractory neuropathic pain are its established indications. In these patients too, the efficacy rate remains around 50 to 75%. The overall pain relief observed is around 50% decrease in visual analog scale (VAS) scores. It is a technically simple procedure involving placement of electrodes over the dorsal aspect of spinal cord in the epidural space. The procedure is a staged one in which trial lead electrodes are first implanted and stimulated with an external pulse generator (EPG). If the trial is successful and patient has acceptable pain relief over 1 week of stimulation at various settings, the patient undergoes the permanent implantation of electrodes at the same position. The permanent electrodes are then stimulated by an implantable pulse generator (IPG) in the subcutaneous pocket (abdominal or gluteal). Complications are rare and are more related to hardware like lead migration and breakage. Since it is does not damage the cord per se, its acceptance as a procedure for pain is known quite well in the Western world. Its availability and cost of implants is the major hurdle in its use in a developing nation like India. Here, we present a technical note and our experience of two cases of thoracic spinal cord stimulation for chronic neuropathic pain at our institution.

Download Full-text

Proteomic analysis of cerebrospinal fluid gives insight into the pain relief of spinal cord stimulation

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2013.07.010 ◽

2013 ◽

Vol 4 (4) ◽

pp. 257-258 ◽

Cited By ~ 1

Author(s):

Anne-Li Lind ◽

Magnus Wetterhall ◽

Marcus Sjödin ◽

Torsten Gordh

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Neuropathic Pain ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Statistical Tests ◽

Cost Effective ◽

Structural Similarity ◽

Cost Effective Treatment ◽

Pain Patients

AbstractAimsNeuropathic pain is caused by a lesion or disease of the somatosensory nervous system affecting approximately 2% of the population. Current pharmacological treatments are ineffective for more than 50% of the patients and often give much adverse effects. Spinal cord stimulation (SCS) is an alternative cost-effective treatment with high efficacy, prolonged pain relief, few side effects. We have compared the cerebrospinal fluid (CSF) proteomes from neuropathic pain patients during pain relief induced by SCS and during pain sensation without SCS, to gain further insights into the mechanisms behind the obtained analgesia.MethodsPaired CSF samples were taken from SCS-responsive neuropathic pain patients after the SCS had been turned off for 48 h and when the SCS had been used normally for three weeks. Thus, each patient acted as their own control. The corresponding proteomes for each patient were relatively quantified using a mass spectrometry based shotgun approach.ResultsIn total, 419 unique proteins were simultaneously identified and relatively quantified. A panel consisting of seven proteins, 5 up-regulated and 2 down, were found to be significantly regulated by SCS in two complementary statistical tests (P ≤ 0.01). The most up-regulated protein in the SCS linked panel is a known modulator of nicotinic acetylcholine (ACh) receptor activity. Interestingly, it has a striking tertiary structural similarity and biological functionality as pain modulating prototoxins found in snake venoms.ConclusionsOur findings reveal possible insights into the mechanism of spinal cord stimulation and the obtained pain relief.

Download Full-text