scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

scholarly journals Neuromodulation of the Cervical Spinal Cord in the Treatment of Chronic Intractable Neck and Upper Extremity Pain: A Case Series and Review of the Literature

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 305-311
Author(s):  
Ricardo Vallejo
Keyword(s):  
Spinal Cord ◽  
Upper Extremity ◽  
Spinal Cord Stimulation ◽  
Cervical Spinal Cord ◽  
Case Series ◽  
Low Back ◽  
Limb Pain ◽  
Fusion Surgery ◽  
Upper Limb Pain ◽  
Pain Patients

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70–90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. Key words: spinal cord stimulator, cervical, neck pain, radicular pain, axial pain, headache, leg pain

Multicentre, clinical trial of burst spinal cord stimulation for neck and upper limb pain NU-BURST: a trial protocol

2021 ◽  
Author(s):  
Adnan Al-Kaisy ◽  
Girish Vajramani ◽  
Sarah Love-Jones ◽  
Nikunj K. Patel ◽  
Jonathan Royds ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Trial Protocol ◽  
Limb Pain ◽  
Multicentre Clinical Trial ◽  
Upper Limb Pain

scholarly journals High-Frequency Spinal Cord Stimulation at 10 kHz for the Treatment of Combined Neck and Arm Pain: Results From a Prospective Multicenter Study

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 176-185 ◽  
Author(s):  
Kasra Amirdelfan ◽  
Ricardo Vallejo ◽  
Ramsin Benyamin ◽  
Cong Yu ◽  
Thomas Yang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Neck Pain ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Limb Pain ◽  
Arm Pain ◽  
System A ◽  
Institutional Review ◽  
Upper Limb Pain

Abstract BACKGROUND Intractable neck and upper limb pain has historically been challenging to treat with conventional spinal cord stimulation (SCS) being limited by obtaining effective paresthesia coverage. OBJECTIVE To assess the safety and effectiveness of the 10-kHz SCS system, a paresthesia-independent therapy, in the treatment of neck and upper limb pain. METHODS Subjects with chronic, intractable neck and/or upper limb pain of ≥5 cm (on a 0-10 cm visual analog scale [VAS]) were enrolled in 6 US centers following an investigational device exemption from the Food and Drug Administration (FDA) and institutional review board approval. Each subject was implanted with 2 epidural leads spanning C2-C6 vertebral bodies. Subjects with successful trial stimulation were implanted with a Senza® system (Nevro Corp) and included in the evaluation of the primary safety and effectiveness endpoints. RESULTS In the per protocol population, the primary endpoint (≥50% pain relief at 3 mo) was achieved in 86.7% (n = 39/45) subjects. Compared to baseline, subjects reported a significant reduction (P < .001) in their mean (± standard error of the mean) VAS scores at 12-mo assessment for neck pain (7.6 ± 0.2 cm, n = 42 vs 1.5 ± 0.3 cm, n = 37) and upper limb pain (7.1 ± 0.3 cm, n = 24 vs 1.0 ± 0.2 cm, n = 20). At 12-mo assessment, 89.2% of subjects with neck pain and 95.0% with upper limb pain had ≥50% pain relief from baseline, 95.0% reported to be “satisfied/very satisfied” and 30.0% either eliminated or reduced their opioid intake. CONCLUSION In conclusion, 10-kHz SCS can treat intractable neck and upper limb pain with stable long-term outcomes.

scholarly journals 1-kHz high-frequency spinal cord stimulation alleviates chronic refractory pain after spinal cord injury: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Chiaki Yamada ◽  
Aiko Maeda ◽  
Katsuyuki Matsushita ◽  
Shoko Nakayama ◽  
Kazuhiro Shirozu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Cervical Vertebrae ◽  
Intractable Pain ◽  
Target Area ◽  
Positive Effects ◽  
Cord Injury

Abstract Background Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. Case presentation A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. Conclusions SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.

Spinal Cord Stimulation for Intractable Pain Following Limb Amputation

2012 ◽  
Vol 16 (6) ◽  
pp. 530-536 ◽  
Author(s):  
John McAuley ◽  
Richard van Gröningen ◽  
Christopher Green
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Limb Amputation ◽  
Intractable Pain

scholarly journals Axillary artery thrombosis resulting in upper limb amputation as a COVID-19 sequela

2021 ◽  
Vol 14 (1) ◽  
pp. e240981
Author(s):  
Riju Ramachandran ◽  
Anoop Vasudevan Pillai ◽  
Suyambu Raja ◽  
Sailakshmi Sailesh
Keyword(s):  
Upper Limb ◽  
Asymptomatic Patient ◽  
Axillary Artery ◽  
Local Area ◽  
Limb Amputation ◽  
Limb Pain ◽  
Local Hospital ◽  
Artery Thrombosis ◽  
Upper Limb Pain ◽  
The Right

Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles’ heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Despite a successful embolectomy at the local hospital, there was re-occlusion of the axillary artery and the limb became ischaemic. He was referred to our institution by which time the limb became gangrenous above the elbow and had to be amputated. Extensive sloughing of the nerves was also seen in the local area. Hypercoagulability presenting with various manifestations is common in COVID-19 and needs early anticoagulation. We present this asymptomatic patient who lost a limb to this COVID-19 sequelae.

scholarly journals Low-Intensity and Short-Duration Continuous Cervical Transcutaneous Spinal Cord Stimulation Intervention Does Not Prime the Corticospinal and Spinal Reflex Pathways in Able-Bodied Subjects

2021 ◽  
Vol 10 (16) ◽  
pp. 3633
Author(s):  
Atsushi Sasaki ◽  
Roberto M. de Freitas ◽  
Dimitry G. Sayenko ◽  
Yohei Masugi ◽  
Taishin Nomura ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Short Duration ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Spinal Reflex ◽  
Therapeutic Effects ◽  
Low Intensity ◽  
Reflex Excitability ◽  
Cord Injury ◽  
Transcutaneous Spinal Cord Stimulation

Cervical transcutaneous spinal cord stimulation (tSCS) has been utilized in applications for improving upper-limb sensory and motor function in patients with spinal cord injury. Although therapeutic effects of continuous cervical tSCS interventions have been reported, neurophysiological mechanisms remain largely unexplored. Specifically, it is not clear whether sub-threshold intensity and 10-min duration continuous cervical tSCS intervention can affect the central nervous system excitability. Therefore, the purpose of this study was to investigate effects of sub-motor-threshold 10-min continuous cervical tSCS applied at rest on the corticospinal and spinal reflex circuit in ten able-bodied individuals. Neurophysiological assessments were conducted to investigate (1) corticospinal excitability via transcranial magnetic stimulation applied on the primary motor cortex to evoke motor-evoked potentials (MEPs) and (2) spinal reflex excitability via single-pulse tSCS applied at the cervical level to evoke posterior root muscle (PRM) reflexes. Measurements were recorded from multiple upper-limb muscles before, during, and after the intervention. Our results showed that low-intensity and short-duration continuous cervical tSCS intervention applied at rest did not significantly affect corticospinal and spinal reflex excitability. The stimulation duration and/or intensity, as well as other stimulating parameters selection, may therefore be critical for inducing neuromodulatory effects during cervical tSCS.

Poster 268: Mirror Therapy for Persistent Upper Limb Pain Following Spinal Cord Tumor Resection: A Case Report

PM&R ◽  
2009 ◽  
Vol 1 ◽  
pp. S220-S220 ◽  
Author(s):  
Gary P. Chimes ◽  
Cheryl D. Bernstein ◽  
Megan H. Cortazzo ◽  
Lynne M. Huber
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Upper Limb ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Mirror Therapy ◽  
Limb Pain ◽  
Upper Limb Pain

Development of an OpenSim Shoulder Model for Manual Wheelchair Users With Tetraplegia

2011 ◽  
Author(s):  
Brooke Odle ◽  
Gail Forrest ◽  
Jeffrey Reinbolt ◽  
Trevor Dyson-Hudson
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Shoulder Injuries ◽  
Limb Pain ◽  
Wheelchair Users ◽  
Manual Wheelchair ◽  
Repetitive Strain Injuries ◽  
Cord Injury ◽  
Repetitive Strain ◽  
Upper Limb Pain

Extended manual wheelchair use has been associated with repetitive strain injuries in the shoulder and has been identified as a contributing factor to upper limb pain experienced by manual wheelchair users with spinal cord injury (SCI) [1]. Due to the nature of their SCI, individuals with tetraplegia (formerly quadriplegia) may be at an even greater risk for developing shoulder injuries because they often have only partial innervation of their shoulder, scapular, and thoracohumeral muscles [2].

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