Management of post-cervical laminectomy fusion pain syndrome with a successful trial of spinal cord stimulation

The authors present the case of a 49-year-old female patient with complex regional pain syndrome–Type I (CRPSI) who was suffering from nonhealing wounds and giant bullae, which dramatically improved after spinal cord stimulation (SCS). The scientific literature concerning severe cutaneous manifestations of CRPS-I and their treatment is reviewed. Nonhealing wounds and bullae are rare manifestations of CRPS-I that are extremely difficult to treat. Immediate improvement of both wounds and bullae after SCS, such as in this case, has not been reported previously in literature. Considering the rapidly progressive nature of these severe skin manifestations, immediate treatment, possibly with SCS, is mandatory.

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Defining minimal clinically important differences in pain and disability outcomes of patients with chronic pain treated with spinal cord stimulation

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201431 ◽

2021 ◽

pp. 1-8

Author(s):

Shelby Sabourin ◽

Justin Tram ◽

Breanna L. Sheldon ◽

Julie G. Pilitsis

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Rating Scale ◽

Numerical Rating Scale ◽

Pain Catastrophizing ◽

Pain Syndrome ◽

Failed Back Surgery Syndrome ◽

Mcgill Pain Questionnaire ◽

Minimum Detectable Change ◽

Failed Back Surgery

OBJECTIVE Minimal clinically important difference (MCID) thresholds for a limited number of outcome metrics were previously defined for patients with failed back surgery syndrome (FBSS) at 6 months after spinal cord stimulation (SCS). This study aimed to further define MCID values for pain and disability outcomes. Additionally, the authors established 1-year MCID values for outcome measures with previously defined metrics commonly used to assess SCS efficacy. METHODS Preoperative and 1-year postoperative outcomes were collected from 114 patients who received SCS therapy for FBSS, complex regional pain syndrome, and neuropathic pain. MCID values were established for the numerical rating scale (NRS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), McGill Pain Questionnaire (MPQ), and Pain Catastrophizing Scale (PCS). Four established anchor-based methods were utilized to compute MCID values with two anchored questions: “Are you satisfied with SCS therapy?” and “Would you have SCS surgery again?” For each question, patients were categorized as responders if they answered “yes” or as nonresponders if they responded “no.” The methodologies utilized to compute MCID scores included the average change method, minimum detectable change approach, change difference calculation, and receiver operating characteristic (ROC) analysis. Area under the ROC curve (AUC) analysis has been shown to inform the accuracy at which the MCID value can distinguish responders from nonresponders and was analyzed for each instrument. RESULTS For the first time, ranges of MCID values after SCS were established for MPQ (1–2.3) and PCS (1.9–13.6). One-year MCID values were defined for all indications: NRS (range 0.9–2.7), ODI (3.5–6.9), and BDI (2–5.9). AUC values were significant for NRS (0.78, p < 0.001), ODI (0.71, p = 0.003), MPQ (0.74, p < 0.001), and PCS (0.77, p < 0.001), indicating notable accuracy for distinguishing satisfied patients. CONCLUSIONS This was the first study to successfully determine MCID values for two prominent instruments, MPQ and PCS, used to assess pain after SCS surgery. Additionally, previously established MCID values for ODI, BDI, and the visual analog scale for patients with FBSS at 6 months after treatment were explored at 12 months for the most common indications for SCS. These data may better inform physicians of patient response to and success with SCS therapy.

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First experience with chronic epidural spinal cord stimulation in Khanty-Mansi autonomous okrug — clinical observations

Neurology Bulletin ◽

10.17816/nb70921 ◽

2021 ◽

Vol LIII (2) ◽

pp. 94-100

Author(s):

Olga A. Bondarenko ◽

Gaspar V. Gavrilov ◽

Vadim A. Padurets ◽

Roman V. Kasich

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Chronic Neuropathic Pain ◽

Neuropathic Pain Syndrome ◽

Epidural Stimulation ◽

Cord Injury ◽

Epidural Spinal Cord Stimulation ◽

And Migration

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.

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The Shared Gabaminergic Mechanism Lends Itself to Treatment of Dystonia in Complex Regional Pain Syndrome With Spinal Cord Stimulation

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200809001-00036 ◽

2008 ◽

Vol 33 (Sup 1) ◽

pp. e21

Author(s):

L. Radhakrishnan ◽

S. Kapur ◽

H. Mutagi ◽

J. Raphael

Keyword(s):

Spinal Cord ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome

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Spinal cord stimulation for complex regional pain syndrome

10.1109/iembs.2009.5334418 ◽

2009 ◽

Cited By ~ 3

Author(s):

M. Shrivastav ◽

S. Musley

Keyword(s):

Spinal Cord ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Pain Syndrome

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Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

Journal of Health Sciences ◽

10.17532/jhsci.2017.399 ◽

2017 ◽

Vol 7 (2) ◽

pp. 68-79 ◽

Cited By ~ 2

Author(s):

Bruno Camporeze ◽

Renata Faria Simm ◽

Iracema Araújo Estevão ◽

Luis Roberto Mathias Junior ◽

Paulo Henrique Pires de Aguiar ◽

...

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Cost Effectiveness ◽

Literature Review ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Cost Effective ◽

Medical Conditions ◽

Reduction Of Pain ◽

Bibliographic Search

Introduction: The spinal cord stimulation (SCS) has been described as a valuable neuromodulating procedure in the management of chronic and medically untreated neuropathic pain. Although, many studies have discussed the use of this technique, a question still remains regarding its efficacy in different medical conditions with different etiology in the long term. The aim of this paper is to discuss the risks, complications, cost-effectiveness and results of SCS in patients affected by chronic neuropathic pain based on the comprehensive literature review. Methods: Bibliographic search of references from 1950 to 2016 using the databases MEDLINE, LILACS, SciELO, PubMed, and applied language as selection criteria, choosing preferably recent articles written in Portuguese, Spanish or English. Results: Based on literature review, SCS is a safe, reversible, adjustable and nondestructive surgical procedure demonstrating a significant effect in the reduction of pain intensity and improvement in quality of life in these patients. Furthermore, in spite of the initial high cost to its application, SCS has been associated with lower rates of complications and high rates of cost-effectiveness when compared to standard therapies. Conclusion: Although used in medical conditions with different etiology, the procedure is still an effective and a cost-effective approach to neuropathic pain, mainly in patients affected by failed back pain syndrome (FBSS) and complex regional pain syndrome (CRPS).

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Patient with Postthoracotomy Pain

10.2310/pm.15013 ◽

2017 ◽

Author(s):

Jianguo Cheng ◽

Olivia T Cheng

Keyword(s):

Spinal Cord ◽

Epidural Analgesia ◽

Spinal Cord Stimulation ◽

Pain Syndrome ◽

Intercostal Nerve ◽

Thoracic Epidural Analgesia ◽

Intercostal Nerve Block ◽

Thoracic Epidural ◽

Postthoracotomy Pain ◽

Intravenous Analgesia

Pain due to thoracotomy is among the most severe pain experienced after surgery. It has both neuropathic and myofascial components. About 50% of patients suffer from chronic postthoracotomy pain 1 year after surgery. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapy for thoracotomy analgesia. Preoperatively initiated thoracic epidural analgesia is associated with better pain control and decreased incidence (and intensity) of chronic postthoracotomy pain compared with postoperative (epidural or intravenous) analgesia. Compared with inhalation anesthesia, total intravenous anesthesia significantly reduced the incidence of chronic postthoracotomy pain syndrome, which is notoriously challenging to treat. Gabapentinoids and antidepressants may be beneficial for the neuropathic component of chronic postthoracotomy pain syndrome. A pregabalin and methylcobalamin combination has been shown to be safe and effective in the treatment of chronic postthoracotomy pain, with minimal side effects. Interventional therapies such as intercostal nerve block or ablation, spinal cord stimulation, and targeted subcutaneous neuromodulation may be indicated in more refractory and debilitating cases. This review contains 1 table, and 57 references. Key words: chronic postthoracotomy pain, cryoneurolysis, intercostal nerve block, open thoracotomy surgery, paravertebral block, postthoracotomy pain, postthoracotomy pain syndrome, spinal cord stimulation, thoracic epidural analgesia, thoracotomy, total intravenous analgesia, video-assisted thoracoscopic surgery

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Spinal cord stimulation for complex regional pain syndrome type 1 with dystonia: a case report and discussion of the literature

F1000Research ◽

10.12688/f1000research.3771.1 ◽

2014 ◽

Vol 3 ◽

pp. 97 ◽

Cited By ~ 1

Author(s):

Caroline Voet ◽

Bernard le Polain de Waroux ◽

Patrice Forget ◽

Ronald Deumens ◽

Etienne Masquelier

Keyword(s):

Spinal Cord ◽

Nervous System ◽

Case Report ◽

Complex Regional Pain Syndrome ◽

Spinal Cord Stimulation ◽

Behavioural Change ◽

Pain Syndrome ◽

Social Model ◽

Syndrome Type

Background: Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating chronic pain disorder, the physiopathology of which can lead to dystonia associated with changes in the autonomic, central and peripheral nervous system. An interdisciplinary approach (pharmacological, interventional and psychological therapies in conjunction with a rehabilitation pathway) is central to progress towards pain reduction and restoration of function.Aim: This case report aims to stimulate reflection and development of mechanism-based therapeutic strategies concerning CRPS associated with dystonia.Case description: A 31 year old female CRPS-1 patient presented with dystonia of the right foot following ligamentoplasty for chronic ankle instability. She did not have a satisfactory response to the usual therapies. Multiple anesthetic blocks (popliteal, epidural and intrathecal) were not associated with significant anesthesia and analgesia. Mobilization of the foot by a physiotherapist was not possible. A multidisciplinary approach with psychological support, physiotherapy and spinal cord stimulation (SCS) brought pain relief, rehabilitation and improvement in the quality of life.Conclusion: The present case report demonstrates the occurrence of multilevel (peripheral and central) pathological modifications in the nervous system of a CRPS-1 patient with dystonia. This conclusion is based on the patient’s pain being resistant to anesthetic blocks at different levels and the favourable, at least initially, response to SCS. The importance of the bio-psycho-social model is also suggested, permitting behavioural change.

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