Application of Spinal Cord Stimulation for the Treatment of Abdominal Visceral Pain Syndromes: Case Reports

Background: Chronic renal pain secondary to uretero-pelvic junction obstruction (UPJO) is common but remains poorly understood. Patients with UPJO experience frequent infections, renal calculi and pain. Management options for patients with this condition are traditionally limited to surgical interventions to eliminate the obstruction. Spinal Cord Stimulation (SCS) has gained widespread popularity for the treatment of numerous conditions from complex regional pain syndrome to failed back syndrome. With continued success, the possible use of SCS has steadily increased. Although a significant number of patients with severe chronic renal pain will transiently respond to analgesics and physical interventions such as autonomic sympathetic blocks, substantial long-term pain relief is usually lacking. SCS therefore might be a welcome addition to the treatment of moderate to severe chronic renal pain. . Objective: This article presents a case of using spinal cord stimulation in the management of chronic renal pain secondary to Uretero-pelvic junction obstruction. Design: Case report Setting: Academic University Pain Management Center Methods: A 38-year old female presented with a 15-year history of persistent right sided flank pain secondary to congenital uretero-pelvic junction obstruction. After failing to respond adequately to stenting, medications and nerve blocks, a trial of spinal cord stimulation and subsequent permanent implantation of a spinal cord stimulator (SCS) were performed. Results: The patient reported significant improvement in pain, overall functioning and no consumption of opioids during the SCS trial and following system implant. Limitations: A case report. Conclusion: Spinal cord stimulation might be an option in the management of chronic renal pain secondary to Uretero-pelvic junction obstruction. Key words: spinal cord stimulation, renal pain, uretero-pelvic jnction obstruction, visceral pain, flank pain, pelvic pain

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Comparison of FDA-Approved Electrical Neuromodulation Techniques for Focal Neuropathic Pain: A Narrative Review of DRG, HF10, and Burst Neuromodulation

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e407 ◽

2021 ◽

pp. E407-E423

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Dorsal Root Ganglion ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Dorsal Root ◽

Case Reports ◽

Case Series ◽

Dorsal Column ◽

Small Sample

BACKGROUND: Evidence suggests that dorsal root ganglion stimulation (DRGS) is a more effective treatment for focal neuropathic pain (FNP) compared with tonic, paresthesia-based dorsal column spinal cord stimulation (SCS). However, new advancements in waveforms for dorsal column SCS have not been thoroughly studied or compared with DRGS for the treatment of FNP. OBJECTIVES: The purpose of this review was to examine the evidence for these novel technologies; to highlight the lack of high-quality evidence for the use of neuromodulation to treat FNP syndromes other than complex regional pain syndrome I or II of the lower extremity; to emphasize the absence of comparison studies between DRGS, burst SCS, and high-frequency SCS; and to underscore that consideration of all neuromodulation systems is more patient-centric than a one-size-fits-all approach. STUDY DESIGN: This is a review article summarizing case reports, case series, retrospective studies, prospective studies, and review articles. SETTING: The University of Miami, Florida. METHODS: A literature search was conducted from February to March 2020 using the PubMed and EMBASE databases and keywords related to DRGS, burst SCS, HF10 (high-frequency of 10 kHz), and FNP syndromes. All English-based literature from 2010 reporting clinical data in human patients were included. RESULTS: Data for the treatment of FNP using burst SCS and HF10 SCS are limited (n = 11 for burst SCS and n = 11 for HF10 SCS). The majority of these studies were small, single-center, nonrandomized, noncontrolled, retrospective case series and case reports with short follow-up duration. To date, there are only 2 randomized controlled trials for burst and HF10 for the treatment of FNP. LIMITATIONS: No studies were available comparing DRGS to HF10 or burst for the treatment of FNP. Data for the treatment of FNP using HF10 and burst stimulation were limited to a small sample size reported in mostly case reports and case series. CONCLUSIONS: FNP is a complex disease, and familiarity with all available systems allows the greatest chance of success. KEY WORDS: Dorsal root ganglion, high frequency, burst, spinal cord stimulation, neuromodulation, focal neuropathic pain

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