scholarly journals Spinal Cord Stimulation for the Treatment of Chronic Renal Pain Secondary to Uretero-Pelvic Junction Obstruction

2011 ◽  
Vol 1;14 (1;1) ◽  
pp. 55-59
Author(s):  
Chong H. Kim
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Pain Management ◽  
Spinal Cord Stimulation ◽  
Visceral Pain ◽  
Flank Pain ◽  
Management Options ◽  
Nerve Blocks ◽  
Number Of Patients ◽  
Patient Reported

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

scholarly journals Spinal Cord Stimulation for Chronic Pain Originating from Lyme Disease

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 511-514
Author(s):  
Yongjie Li
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Case Report ◽  
Pain Management ◽  
Lyme Disease ◽  
Spinal Cord Stimulation ◽  
Single Case ◽  
Management Options ◽  
Single Case Report ◽  
Patient Reported

Background: Neuropathic pain is a relatively common outcome of Lyme disease. Pain management options for these patients have been limited to pharmaceutical treatments. Objective: We present a case of chronic pain following Lyme disease treated successfully using spinal cord stimulation (SCS). Study Design: Case report. Setting: Pain management clinic. Methods: A 62-year-old patient presented with a 5-year history of bilateral foot pain following Lyme disease that failed to respond to medication and physical therapy. The patient was treated by a trial of SCS at the clinic and then implanted with a spinal cord stimulator. The Visual Analog Scale (VAS) assessed pain before and after SCS. Results: The patient reported significant pain relief and improved foot function. The 10 point VAS score was reduced from 8−10 to 1–3. Limitations: Single case report. Conclusion: Spinal cord stimulation may be an effective option for relieving chronic pain originating from Lyme disease. Key words: Spinal cord stimulation, Lyme disease, chronic pain.

scholarly journals Spinal Cord Stimulation for the Treatment of Chronic Knee Pain Following Total Knee Replacement

2010 ◽  
Vol 3;13 (3;5) ◽  
pp. 251-256
Author(s):  
Thomas T. Simopoulos
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Total Knee Replacement ◽  
Knee Pain ◽  
Knee Replacement ◽  
Spinal Cord Stimulation ◽  
Management Options ◽  
Chronic Knee Pain ◽  
Patient Reported ◽  
Total Knee

Background: Chronic pain after total knee replacement is common but remains poorly understood. Management options for patients with this condition are traditionally limited to pharmacological approaches. Objective: This article presents a case of using spinal cord stimulation in the management of chronic knee pain following total knee replacement. Design: Case report Setting: Pain management clinic Methods: A 68-year old patient presented with a 3-year history of persistent knee pain following total knee replacement. After failing to respond to medications and nerve blocks, a trial of spinal cord stimulation and subsequent permanent implantation of a spinal cord stimulator (SCS) were performed. The Oxford knee score (OKS) was used to assess her pain and functionality before and after SCS implantation. Results: The patient reported improvement in her pain and function. Her baseline OKS was 39 and fell to 26 one year post implantation of an SCS representing a reduction of pain and disability from severe to moderate. Limitations: A case report. Conclusion: Spinal cord stimulation might be an option in the management of refractory knee pain following total knee replacement. Key Words: total knee replacement, knee pain, spinal cord stimulation

scholarly journals Spinal cord stimulation in the management of neuropathic pain in cancer patients: case report

2020 ◽  
Vol 49 (2) ◽  
Author(s):  
Valeria Quintero-Carreño ◽  
Bilena Margarita-Molina ◽  
Carlos Hernán Rodríguez-Martínez
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Cancer Patients ◽  
Spinal Cord Stimulation ◽  
Femoral Nerve ◽  
Chronic Neuropathic Pain ◽  
Nerve Blocks ◽  
Curative Intent ◽  
Number Of Patients ◽  
Improved Function

Introduction: Neuropathic pain is present in up to 40 % of all cancer patients. A considerable number of patients fail to achieve enough pain relief with conventional treatment, which is why therapeutic alternatives such as spinal cord stimulation should be considered. Case description and results: This is the case of a female patient with chronic neuropathic pain secondary to a partial femoral nerve injury sustained during resection and lymph node dissection surgery with curative intent for a large stage II cell squamous cell carcinoma T2N0M0, localized in the right popliteal fossa. The patient presented with difficult to manage chronic neuropathic pain, despite receiving multiple oral analgesics and nerve blocks. A medullary neurostimulator was implanted that relieved the patient’s pain intensity in up to 80%, in addition to improved function and quality of life. Conclusions: spinal cord stimulation is considered an effective neuromodulatory intervention which has shown satisfactory results in the treatment of various types of refractory chronic pain in cancer patients, including neuropathic pain.

scholarly journals SPINAL CORD STIMULATION IN BUERGER’S DISEASE – A CASE REPORT

2019 ◽  
pp. 41-48
Author(s):  
Olga Santos
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Stimulation ◽  
Buerger’S Disease ◽  
Buerger's Disease ◽  
Transcutaneous Oxygen ◽  
Patient Reported ◽  
Transcutaneous Oxygen Pressure

Buerger’s disease (BD) or thromboangeitis obliterants is a nonatherosclerotic segmental inflammation of the medium- and small-size arteries and vessels of the extremities. The pathogenesis of this process remains unclear. This disease is typically seen in male smokers under 45 years of age, and successful therapy is possible only with abstinence from tobacco. Methods to control ischemic pain include nonpharmacological and pharmacological options, such as prostanoids, or surgical intervention (sympathectomy or revascularization). This case report describes an unusual case of Buerger’s disease in a 60-year-old woman with a moderate smoking habit. Despite apparent tobacco abstinence and therapeutic optimization, there was no clinical improvement in this patient with pharmacological treatment. Attending to the imminent risk of amputation of her fingers, spinal cord stimulation (SCS) system implantation was the chosen therapeutic option. Transcutaneous oxygen pressure (TcPO2) was measured at different points in time after implantation and there was a significant increment of TcPO2 in both hands. In fact, the patient reported no pain after the first month of spinal stimulation; analgesics were progressively reduced and complete healing of ulcers was achieved. Furthermore, the patient reported a substantial improvement in her quality of life and total functional recovery in her hands mobilization after 6 months of treatment. The Brief Pain Inventory Scale and EuroQol- 5D scale were used to evaluate disease progression and its impact on quality of life. SCS system implantation is considered a safe procedure and cost-effective in the long term. The mechanisms behind these effects are still unknown, but SCS is a promising treatment option. More studies that include larger numbers of patients are needed. Key words: Buerger, tobacco, ischemia, amputation, electrical spinal cord stimulation, transcutaneous oxygen pressure

scholarly journals Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Training Hospital, Istanbul, Turkey

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 263-270
Author(s):  
Lei Sima
Keyword(s):  
Spinal Cord ◽  
Pain Management ◽  
Calcium Channel ◽  
Postherpetic Neuralgia ◽  
Spinal Cord Stimulation ◽  
Therapeutic Effects ◽  
Pulsed Radiofrequency ◽  
Calcium Channel Antagonists ◽  
Number Of Patients ◽  
Post Operation

Background: Postherpetic neuralgia (PHN) occurs in 9% to 34% of herpes zoster (HZ) patients, and the incidence of PHN is positively correlated with age. A number of patients suffer from poor therapeutic effects or intolerable side effects and need to accept minimally invasive analgesia. Objectives: This study aimed to investigate the effects of spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) on the treatment of elderly patients with HZ-related pain persisting beyond the acute phase. Study Design: A prospective, randomized-controlled trial. Setting: Research was conducted at the National Pain Management and Research Center, ChinaJapan Friendship Hospital (Beijing, China). Methods: We selected 63 patients aged over 50 years with zoster-related pain of 1 to 6 months onset. They were randomly divided into an SCS group and a PRF group. In the SCS group, the stimulus electrodes were placed in the affected spinal ganglion segment of the epidural space for 2 weeks. In the PRF group, the radiofrequency needle was percutaneously punctured in the affected dorsal root ganglion. The main outcome measures were the Numeric Rating Scale (NRS-11) score, response rate, and complete remission rate. The secondary endpoint was defined as the use of analgesics and calcium channel antagonists. Results: The NRS-11 score in the SCS group decreased to 2.90 ± 1.83 (1 week post operation) and 4.37 ± 2.43 (24 weeks post operation), while that in the PRF group decreased to 3.13 ± 1.78 and 4.23 ± 2.64, respectively (compared with baseline, P < .001); there was no significant difference between the 2 groups (P > .05) . The effective rate of pain management was in the range of 56.67% to 81.25%, and the complete pain relief rate ranged from 37% to 71%. The number of patients still using analgesics and calcium channel antagonists after operation were significantly less than those pre-operation (P < .001). Univariate and multivariate logistic regression analyses showed that the operation method, age, gender, and course of disease did not affect surgical efficacy. Limitations: The main limitation of this study is that all the cases were from the same center. Conclusion: It therefore can be concluded that SCS and PRF can effectively relieve PHN. Key words: Spinal cord stimulation, pulsed radiofrequency, postherpetic neuralgia

Pain Management Techniques for Loin Pain Hematuria Syndrome Case Report

2020 ◽  
pp. 141-144
Author(s):  
Sarang Koushik
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Stimulation ◽  
Renal Denervation ◽  
Treatment Options ◽  
Disease Process ◽  
Current Treatment ◽  
Flank Pain ◽  
Loin Pain ◽  
Loin Pain Hematuria Syndrome

Background: Loin pain hematuria syndrome (LPHS) is a rare syndrome presenting with chronic unilateral or bilateral flank pain and gross or microscopic hematuria. Case Report: We present a case of LPHS in a male with past medical history of atrial fibrillation, Barrett’s esophagus, and loin pain hematuria syndrome who initially presented to our medical facility with gross hematuria, intractable left flank pain, and non-bloody emesis. Our case exemplifies the challenge in managing patients with LPHS. Conclusion: Without a definitive mechanism for LPHS, current treatment focuses on symptom management. Analgesics (non-opioid and opioid) may be used orally or intravenous depending on the presence of concomitant nausea and vomiting. For patients at risk of opioid dependence, targeting afferent pain fibers originating from the kidneys and ureters has proven a successful analgesic strategy. Surgical options for renal denervation include: endovascular radiofrequency ablation, laparoscopic renal denervation, and renal auto transplant. Treatment options for this disease process include intra-ureteric bupivacaine, renal denervation, and possible spinal cord stimulation. Key words: Flank pain, loin pain hematuria syndrome, renal denervation, spinal cord stimulation

Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Alternative Therapy ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Number Of Patients ◽  
Chronic Pain Conditions ◽  
Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

Postoperative Pain Management

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Clinical Information ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Management Options ◽  
Nerve Blocks ◽  
Epidural Catheter Placement ◽  
Opiate Abuse ◽  
Regional Nerve Block

The aim of this review is to provide practical clinical information on modern pain management options to guide the clinician on evidence-based practices, optimizing the treatment of pain and avoiding practices that may lead to potential abuse. Postoperative pain management is an essential component of any surgeon’s practice and has clear implications for surgical outcomes, patient satisfaction, and population health. Understanding options within a multimodal approach to pain management in the acute setting is a key determinant to improving outcomes for our patients. This review discusses multimodal analgesic options, including a variety of pain medications (opiates, antiinflammatory medications, and patient-controlled analgesia) and techniques (epidural catheter placement, regional nerve blocks) to be used in tandem. Lastly, best possible practices to avoid opiate abuse are discussed. This review contains 4 figures, 5 tables, 1 video and 96 references. Key words: antiinflammatories, epidural, narcotics, patient-controlled analgesia, postoperative pain, regional nerve block

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