The Predictive Value of Sympathetic Block for the Success of Spinal Cord Stimulation

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 626-633 ◽  
Author(s):  
E. Daniela Hord ◽  
Steven P. Cohen ◽  
G. Rees Cosgrove ◽  
Shihab U. Ahmed ◽  
Ricardo Vallejo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Predictive Value ◽  
Massachusetts General Hospital ◽  
Pain Syndrome ◽  
Walter Reed Army Medical ◽  
Good Pain Relief

Abstract OBJECTIVE The purpose of this study was to assess the predictive value of response to sympathetic blockade (SB) on the success rate of spinal cord stimulation (SCS) in patients with complex regional pain syndrome. METHODS We performed a retrospective study on 23 patients with complex regional pain syndrome who underwent both SB and subsequent SCS trials in the past 3 years at the Massachusetts General Hospital Pain Center, Boston, MA, and Walter Reed Army Medical Center, Washington, DC. Fifteen of these patients underwent permanent placement of an SCS device, and pain relief at 1- and 9-month follow-up was recorded. RESULTS Among the 23 patients included in the study, those having transient pain relief with SB were more likely to have a positive SCS trial: all 13 with positive SB had good pain relief during the trial, compared with only 3 of the 10 with negative SB (100% versus 30%, P < 0.001). Among the 10 patients with negative SB, 7 noted poor pain relief during the trial despite adequate coverage, and they did not undergo placement of a permanent device. Among the patients who underwent permanent placement of an SCS device, those who received good pain relief with SB were more likely to have greater than 50% pain relief at 1-month follow-up (100% versus 33%, P = 0.029) and 9-month follow-up (87.5% versus 33.3%, P = 0.15). CONCLUSION We conclude that patients with good response to SB before SCS are more likely to have a positive response during their SCS trial and long-term pain relief after placement of permanent SCS device.

Spinal Cord Stimulation Is Effective in Management of Complex Regional Pain Syndrome I: Fact or Fiction

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 566-580 ◽  
Author(s):  
Krishna Kumar ◽  
Syed Rizvi ◽  
Sharon Bishop Bnurs
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Functional Status ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Sf 36

Abstract BACKGROUND: Complex regional pain syndrome (CRPS) I is a debilitating neuropathic pain disorder characterized by burning pain and allodynia. Spinal cord stimulation (SCS) is effective in the treatment of CRPS I in the medium term but its long-term efficacy and ability to improve functional status remains controversial. OBJECTIVE: To evaluate the ability of SCS to improve pain, functional status, and quality of life in the long term. METHODS: We retrospectively analyzed 25 patients over a mean follow-up period of 88 months. The parameters for evaluation were visual analog scale (VAS), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), EuroQoL-5D (EQ-5D) and Short Form 36 (SF-36), and drug consumption. Evaluations were conducted at point of entry, 3 months, 12 months, and last follow-up at 88 months (mean). RESULTS: At baseline, the mean scores were VAS 8.4, ODI 70%, BDI 28, EQ-5D 0.30, and SF-36 24. In general, maximum improvement was recorded at follow-up at 3 months (VAS 4.8, ODI 45%, BDI 15, EQ-5D 0.57, and SF-36 45). At last follow-up, scores were 5.6, 50%, 19, 0.57, and 40, respectively. Despite some regression, at last follow-up benefits were maintained and found to be statistically significant (P < .001) compared with baseline. Medication usage declined. SCS did not prevent disease spread to other limbs. Best results were achieved in stage I CRPS I, patients under 40 years of age, and those receiving SCS within 1 year of disease onset. CONCLUSION: SCS improves pain, quality of life, and functional status over the long term and consequently merits early consideration in the treatment continuum.

Spinal Cord Stimulation for Chronic Pain Relief: First Experience in Baltics

2011 ◽  
Vol 11 (1) ◽  
pp. 180-181
Author(s):  
Iveta Golubovska ◽  
Aleksejs Miscuks ◽  
Vitolds Jurkevics ◽  
Sarmite Skaida
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Pain Relief ◽  
Low Income ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Neuropathic Pain Syndrome ◽  
Patient Status ◽  
First Case

Spinal Cord Stimulation for Chronic Pain Relief: First Experience in BalticsWe report the first case of spinal cord stimulator implantation in Baltics to patient with massive posttraumatic plexus lumbosacralis dxtr lesion, severe neuropathic pain syndrome and drug addiction problems. Follow-up time is 6 month since December 2011 and we have observed an obvious clinical and social improvement in patient status. Besides significant pain relief she has got employed and is tax payer instead of low-income person.

scholarly journals Outcomes of Sympathetic Blocks in the Management of Complex Regional Pain Syndrome

2019 ◽  
Vol 131 (4) ◽  
pp. 883-893 ◽  
Author(s):  
Jianguo Cheng ◽  
Vafi Salmasi ◽  
Jing You ◽  
Michael Grille ◽  
Dongsheng Yang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Pain Reduction ◽  
Secondary Outcome ◽  
Predictive Values ◽  
Sympathetic Blocks

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sympathetic dysfunction may be present in complex regional pain syndrome, and sympathetic blocks are routinely performed in practice. To investigate the therapeutic and predictive values of sympathetic blocks, the authors test the hypotheses that sympathetic blocks provide analgesic effects that may be associated with the temperature differences between the two extremities before and after the blocks and that the effects of sympathetic blocks may predict the success (defined as achieving more than 50% pain reduction) of spinal cord stimulation trials. Methods The authors performed a retrospective study of 318 patients who underwent sympathetic blocks in a major academic center (2009 to 2016) to assess the association between pain reduction and preprocedure temperature difference between the involved and contralateral limbs. The primary outcome was pain improvement by more than 50%, and the secondary outcome was duration of more than 50% pain reduction per patient report. The authors assessed the association between pain reduction and the success rate of spinal cord stimulation trials. Results Among the 318 patients, 255 were diagnosed with complex regional pain syndrome and others with various sympathetically related disorders. Successful pain reduction (more than 50%) was observed in 155 patients with complex regional pain syndrome (155 of 255, 61%). The majority of patients (132 of 155, 85%) experienced more than 50% pain relief for 1 to 4 weeks or longer. The degree and duration of pain relief were not associated with preprocedure temperature parameters with estimated odds ratio of 1.03 (97.5% CI, 0.95–1.11) or 1.01 (97.5% CI, 0.96–1.06) for one degree decrease (P = 0.459 or 0.809). There was no difference in the success rate of spinal cord stimulation trials between patients with or without more than 50% pain relief after sympathetic blocks (35 of 40, 88% vs. 26 of 29, 90%, P > 0.990). Conclusions The authors conclude that sympathetic blocks may be therapeutic in patients with complex regional pain syndrome regardless of preprocedure limb temperatures. The effects of sympathetic blocks do not predict the success of spinal cord stimulation.

Burst Spinal Cord Stimulation in a Patient with Complex Regional Pain Syndrome: A 2-year Follow-Up

Pain Practice ◽  
2015 ◽  
Vol 15 (6) ◽  
pp. E59-E64 ◽  
Author(s):  
Nadia Kriek ◽  
George Groeneweg ◽  
Frank J. P. M. Huygen
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome

Pain Relief in Complex Regional Pain Syndrome due to Spinal Cord Stimulation Does Not Depend on Vasodilation

2000 ◽  
Vol 92 (6) ◽  
pp. 1653-1660 ◽  
Author(s):  
Marius A. Kemler ◽  
Gerard A. M. Barendse ◽  
Maarten van Kleef ◽  
Mirjam G. A. oude Egbrink
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Sympathetic Tone ◽  
Skin Microcirculation ◽  
Control Subjects ◽  
Vasodilatory Effect ◽  
Hands And Feet

Background Spinal cord stimulation (SCS) is known to relieve pain in patients with complex regional pain syndrome (CRPS) and, in general, to cause vasodilation. The vasodilatory effect of SCS is hypothesized to be secondary to inhibition of sympathetically mediated vasoconstriction, or through antidromic impulses resulting in release of vasoactive substances. The aim of the present study was to assess whether pain relief in CRPS after SCS is, in fact, dependent on vasodilation. In addition, we tried to determine which of the potential mechanisms may cause the vasodilatory effect that is generally found after SCS. Methods Twenty-four of 36 patients with unilateral CRPS responded to the test of SCS. Twenty-two of these 24 responders (hand, n = 14; foot, n = 8) who had undergone previous sympathectomy were enrolled for the study. In addition, 20 control subjects (10 controls for each extremity) were studied. By means of laser Doppler flowmetry, the skin microcirculation of the patients was measured bilaterally while the SCS system was switched off and while it was activated. Control subjects (n = 20) were tested once only. The ratio of the rest flow at heart level and the dependent position was defined as the vasoconstriction index. Results Both in affected hands and feet, patients were found to have lower vasoconstriction indices (P < 0.01) as compared with controls, indicating a decreased sympathetic tone. Applying SCS did not result in any microcirculatory change as compared with baseline or the contralateral clinically unaffected side. Conclusions The current study failed to show that SCS influences skin microcirculation in patients with CRPS and a low sympathetic tone. Therefore, we may conclude that pain relief in CRPS due to SCS is possible without vasodilation. Because sympathetic activity was greatly decreased in our patients, these results support the hypothesis that the vasodilation that is normally found with SCS is due to an inhibitory effect on sympathetically maintained vasoconstriction.

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