A Nationwide Survey of Spinal Cord-Related Pain Syndrome in Japan: Clinical Characteristics and Treatment

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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Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation

Cardiology in the Young ◽

10.1017/s1047951100009744 ◽

2000 ◽

Vol 10 (4) ◽

pp. 413-415 ◽

Cited By ~ 3

Author(s):

Luc M Beauchesne ◽

Angela Mailis ◽

Gary D Webb

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Aortic Coarctation ◽

Surgical Repair ◽

Rare Complication ◽

Pain Syndrome ◽

Neuropathic Pain Syndrome ◽

Cord Injury ◽

Unusual Symptoms ◽

Arterial Branch

AbstractInjury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.

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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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Spinal Cord Electrical Stimulation for Refractory Angina Treatment

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1594256 ◽

2017 ◽

Vol 38 (04) ◽

pp. 272-278

Author(s):

Gustavo Veloso Lages ◽

Jose Oswaldo Oliveira Júnior

Keyword(s):

Cardiovascular Disease ◽

Spinal Cord ◽

Neuropathic Pain ◽

Electrical Stimulation ◽

Visceral Pain ◽

Pain Syndrome ◽

Refractory Angina ◽

Family Disruption ◽

Appropriate Treatment ◽

Absence From Work

AbstractCardiovascular disease (CVD) is the main cause of death worldwide, including in Brazil. Angina pectoris is a challenging disease because its clinical manifestation is not always related to the degree of obstruction. Visceral pain from any source can be totally disabling. It influences all aspects of the life of a patient and it can be one of the main causes of absence from work and of family disruption. Spinal cord electrical stimulation (SCES) has been traditionally applied for the treatment of neuropathic pain, with good to excellent results. Visceral pain syndrome can be as debilitating and disabling as somatic or neuropathic pain; however, there seems to be a lack of consensus on the appropriate treatment and strategies for these disorders. The major difference of SCES for visceral pain, compared to postlaminectomy syndrome or to regional complex syndrome, is the number of stimulated dermatomes. In most viscera, the somatotopic arrangement has two to four medullar levels, sometimes requiring laterality. After reviewing the literature, we have concluded that SCES is now a viable, low-risk option with satisfactory results for the treatment of neuropathic and visceral pain; therefore, it can be used in refractory angina after the failure of standard therapy. However, further studies are required to increase the application and efficacy of this procedure in the clinical practice.

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