A Case of Spinal Cord Stimulation in
Raynaud’s Phenomenon: Can Subthreshold
Sensory Stimulation Have an Effect?

Spinal cord stimulation is currently used to treat a variety of chronic intractable painful conditions. We report a case of severe Raynaud’s phenomenon in the hands refractory to conservative treatment and responsive to diagnostic stellate ganglion block that was effectively treated with a spinal cord stimulator placed in the cervical epidural space. After capturing the affected areas with paresthesias, blood flow in the left hand and fingers significantly improved as evidenced by an increase in skin temperature, a change from cyanotic to pink appearance and concomitant reduction in pain. Moreover, the patient reported that limb ischemia and pain could be managed overnight with stimulation intensities that were below sensory perception thresholds. Thus it seems, at least in the overnight period, paresthesias were not required to maintain pain relief. This case presents a potential divergence between a requirement for paresthesias and pain relief in spinal cord stimulation therapy for the treatment of Raynaud’s phenomenon. The possible role of the sympathetic nervous system in this relationship is also discussed. Key words: spinal cord stimulator, Raynaud’s phenomenon, sensory perception

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High Frequency Spinal Cord Stimulation in a Patient with Bilateral Cochlear Implants

Pain Management Case Reports ◽

10.36076/pmcr.2021.5.189 ◽

2021 ◽

pp. 189-191

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Cochlear Implant ◽

Cochlear Implants ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Pain Clinic ◽

Bilateral Cochlear Implants ◽

Patient Reported

BACKGROUND: High-frequency spinal cord stimulation (HF-SCS) has become very popular in the management of chronic pain worldwide. As it relies on generating high-frequency electrical impulses, there is a risk of interference with other devices such as cochlear implants that utilize similar principles. A literature search did not reveal any case reports of HF-SCS implantation in a patient with cochlear implants. CASE REPORT: A 75-year-old White woman with a history of bilateral cochlear implants (Cochlear Americas Nucleus® with cp910 processor) for severe sensorineural hearing loss presented to our chronic pain clinic with lumbosacral radiculopathy. The patient underwent a HF-SCS trial with entry point at the L1-L2 space and the leads positioned at the top and bottom of T8. The patient did not experience any auditory interference with her Cochlear implant at triple the average SCS stimulation strength. During the follow-up visit the next week, the patient reported nearly 80% symptomatic pain relief and significant functional improvement. There was no change in her hearing and no evidence of interference. The patient ultimately underwent percutaneous SCS paddle electrode placement and at 3 months, continues to have excellent pain relief without any auditory interactions. CONCLUSION: We successfully implanted a HF-SCS at the thoracic level in a patient with bilateral cochlear implants without any auditory interference. KEY WORDS: Cochlear implant, lumbar radiculopathy, spinal cord stimulation

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Clinical and Objective Data of Spinal Cord Stimulation for the Treatment of Severe Raynaud's Phenomenon

EJVES Extra ◽

10.1053/ejvx.2000.0002 ◽

2001 ◽

Vol 1 (1) ◽

pp. 3-4

Author(s):

B. Neuhauser ◽

R. Perkmann ◽

P.J. Klinger ◽

S. Giacomuzzi ◽

A. Kofler ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Objective Data

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Successful Spinal Cord Stimulation for Necrotizing Raynaud’s Phenomenon in COVID-19 Affected Patient: The Nightmare Comes Back

Cureus ◽

10.7759/cureus.14569 ◽

2021 ◽

Author(s):

Mariateresa Giglio ◽

Angela Preziosa ◽

Martina Rekatsina ◽

Omar Viswanath ◽

Ivan Urits ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Affected Patient

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Sensor-Driven Position-Adaptive Spinal Cord Stimulation for Chronic Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/1 ◽

2012 ◽

Vol 1;15 (1;1) ◽

pp. 1-12

Author(s):

David Schultz

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Adverse Events ◽

Spinal Cord Stimulation ◽

Rating Scale ◽

Body Position ◽

Primary Objective ◽

Position Sensing ◽

Manual Adjustment ◽

Patient Reported

Background: Variation in the intensity of neurostimulation due to body position is a practical problem for many patients implanted with spinal cord stimulation (SCS) systems because positional changes may result in overstimulation or understimulation that leads to frequent need for compensatory manual programming adjustments. Objectives: The purpose of this study was to assess the safety and effectiveness of a novel type of SCS therapy designed to automatically adapt stimulation amplitude in response to changes in a patient’s position or activity. The primary objective of the study was to demonstrate that automatic position-adaptive SCS benefited patients in terms of pain relief and/or convenience compared with neurostimulation adjusted with conventional manual programming. Secondary objectives included assessment of worsened pain relief with automatic adjustment; change in pain score; and the number of manual programming adjustments with position-adaptive neurostimulation compared with manual programming. Study Design: Prospective, multicenter, open-label, randomized crossover study. Setting: Ten interventional pain management centers in the US. Methods: Patients were enrolled a minimum of one week after a successful SCS screening trial. They were then implanted with the RestoreSensorTM neurostimulation device (Medtronic, Inc., Minneapolis, MN) that could be programmed to either automatic position-adaptive stimulation (AdaptiveStimTM) or manual adjustment of stimulation parameters. After implant, all devices were programmed to conventional manual adjustment for a 4-week postoperative period. The patients were then randomized to either conventional manual programming adjustment or position-adaptive stimulation with crossover to the opposite treatment arm occurring at 6 weeks after randomization. The patients were followed for another 6 weeks after crossover. This study was conducted under an FDA-approved Investigational Device Exemption (IDE) and approval of the responsible Institutional Review Boards (IRBs) of the study centers. Results: Seventy-nine patients were enrolled in the study. In an intent-to-treat analysis, 86.5% of patients achieved the primary objective of improved pain relief with no loss of convenience or improved convenience with no loss of pain relief using automatic position-adaptive stimulation compared with using conventional manual programming adjustment alone. This was statistically significantly greater than the predefined minimum success rate of 25%, P < 0.001 (exact one-sided 97.5% lower confidence limit was 76.5%). Only 2.8% of patients reported worsened pain relief during position-adaptive stimulation compared with manual programming. There was a statistically significant reduction in the mean numeric pain rating scale score compared with baseline scores in both treatment arms. Additionally, position-adaptive stimulation demonstrated a statistically significant 41% reduction in the daily average number of programming button presses for amplitude adjustment compared with manual programming (18.2 per day versus 30.7 per day, P = 0.002). Functional improvements reported with position-adaptive stimulation included: improved comfort during position changes (80.3%); improved activity (69%); and improved sleep (47.9%). Adverse events associated with uncomfortable sensations from stimulation did not differ significantly between treatment arms. The incidence of device-related serious adverse events was 3.9%. Limitations: Patients and physicians were not blinded to whether devices were programmed to automatic position-adaptive stimulation or manual adjustment. Responses to assessment questionnaires were based on patient recall. Conclusions: The study demonstrated that automatic position-adaptive stimulation is safe and effective in providing benefits in terms of patient-reported improved pain relief and convenience compared with using manual programming adjustment alone. Key words: spinal cord stimulation, neurostimulation, position sensing, physical activity accelerometer, neuromodulation, effectiveness, pain relief, position-adaptive stimulation, posture-adaptive stimulation, AdaptiveStim Clinical Trial: NCT01106404

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Complete Relief of a Severe Feet and Hand Necrotising Raynaud’s Phenomenon with Double Epidural Cervical and Dorsal Spinal Cord Stimulation

10.29011/2574-7754.100289 ◽

2020 ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Raynaud’S Phenomenon ◽

Raynaud's Phenomenon ◽

Complete Relief ◽

Dorsal Spinal Cord ◽

Dorsal Spinal

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Interventional Treatments for Postherpetic Neuralgia: A Systematic Review

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.209 ◽

2019 ◽

Vol 3 (22;3) ◽

pp. 209-228 ◽

Cited By ~ 13

Author(s):

Chia-Shiang Lin

Keyword(s):

Spinal Cord ◽

Botulinum Toxin ◽

Peripheral Nerve ◽

Nerve Stimulation ◽

Postherpetic Neuralgia ◽

Spinal Cord Stimulation ◽

Stellate Ganglion ◽

Stellate Ganglion Block ◽

Peripheral Nerve Stimulation ◽

Ganglion Block

Background: Postherpetic neuralgia, a persistent pain condition often characterized by allodynia and hyperalgesia, is a deleterious consequence experienced by patients after an acute herpes zoster vesicular eruption has healed. The pain associated with postherpetic neuralgia can severely affect a patient’s quality of life, quality of sleep, and ability to participate in activities of daily living. Currently, first-line treatments for this condition include the administration of medication therapies such as tricyclic antidepressants, pregabalin, gabapentin, and lidocaine patches, followed by the application of tramadol and capsaicin creams and patches as second- or third-line therapies. As not all patients respond to such conservative options, however, interventional therapies are valuable for those who continue to experience pain. Objective: This review focuses on interventional therapies that have been subjected to randomized controlled trials for the treatment of postherpetic neuralgia, including transcutaneous electrical nerve stimulation; local botulinum toxin A, cobalamin, and triamcinolone injection; intrathecal methylprednisolone and midazolam injection; stellate ganglion block; dorsal root ganglion destruction; and pulsed radiofrequency therapy. Study Design: Systematic review Setting: Hospital department in Taiwan Methods: Search of PubMed database for all randomized controlled trials regarding postherpetic neuralgia that were published before the end of May 2017. Results: The current evidence is insufficient for determining the single best interventional treatment. Considering invasiveness, price, and safety, the subcutaneous injection of botulinum toxin A or triamcinolone, transcutaneous electrical nerve stimulation, peripheral nerve stimulation, and stellate ganglion block are recommended first, followed by paravertebral block and pulsed radiofrequency. If severe pain persists, spinal cord stimulation could be considered. Given the destructiveness of dorsal root ganglion and adverse events of intrathecal methylprednisolone injection, these interventions should be carried out with great care and only following comprehensive discussion. Limitations: Although few adverse effects were reported, these procedures are invasive, and a careful assessment of the risk-benefit ratio should be conducted prior to administration. Conclusion: With the exception of intrathecal methylprednisolone injection for postherpetic neuralgia, the evidence for most interventional procedures used to treat postherpetic neuralgia is Level 2, according to “The Oxford Levels of Evidence 2”. Therefore, these modalities have received only grade B recommendations. Despite the lack of a high level of evidence, spinal cord stimulation and peripheral nerve stimulation are possibly useful for the treatment of postherpetic neuralgia. Key words: Interventional treatment, postherpetic neuralgia, botulinum toxin, steroid, stellate ganglion block, peripheral nerve stimulation, paravertebral block, radiofrequency, spinal cord stimulation

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Spinal Cord Stimulation: A Contemporary Series

Neurosurgery ◽

10.1227/00006123-199101000-00011 ◽

1991 ◽

Vol 28 (1) ◽

pp. 65-71 ◽

Cited By ~ 78

Author(s):

Roberto Spiegelmann ◽

William A. Friedman

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Pain Relief ◽

Literature Review ◽

General Anesthesia ◽

Detailed Analysis ◽

Spinal Cord Stimulation ◽

Significant Pain ◽

Experience Pain

Abstract Forty-three patients with chronic pain disorders of different causes were selected for spinal cord stimulation. All underwent implantation of a ribbon electrode through a small laminotomy, under general anesthesia. Thirteen patients (30%) failed to obtain significant pain relief during a period of trial stimulation, and their electrodes were removed. The remainder underwent a definitive implant and were followed for a mean of 13 months (range, 3-33 months). Nineteen of them (63%) continued to experience pain relief. A detailed analysis of this series, as well as a literature review, is presented.

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