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

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

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

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/55 ◽

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

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Pain Management in Postherpetic Neuralgia: Emerging New Therapeutic Options Besides Spinal Cord Stimulation

Neuromodulation Technology at the Neural Interface ◽

10.1111/j.1525-1403.2012.00470.x ◽

2012 ◽

Vol 15 (3) ◽

pp. 267-267

Author(s):

Shailendra Kapoor

Keyword(s):

Spinal Cord ◽

Pain Management ◽

Postherpetic Neuralgia ◽

Spinal Cord Stimulation ◽

Therapeutic Options

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Bipolar High-Voltage, Long-Duration Pulsed Radiofrequency Improves Pain Relief in Postherpetic Neuralgia

January 2018 - Pain Physician ◽

10.36076/ppj/2019/19.e721 ◽

2016 ◽

Vol 5;19 (5;19) ◽

pp. E721-E728

Author(s):

Tao Song

Keyword(s):

Clinical Trial ◽

High Voltage ◽

Postherpetic Neuralgia ◽

Short Form ◽

Control Group ◽

Therapeutic Effects ◽

Pulsed Radiofrequency ◽

Long Duration ◽

Number Of Patients ◽

Sf 36

Background: Postherpetic neuralgia (PHN) is often refractory to existing treatments. Treatment of the dorsal root ganglion (DRG) using monopolar pulsed radiofrequency (PRF), which is a nonor minimally neurodestructive technique, is not efficacious in all patients. Objectives: This study aimed to determine the safety and clinical efficacy of bipolar highvoltage, long-duration PRF on the DRG in PHN patients. Study Design: Self before-after controlled clinical trial. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety patients diagnosed with PHN for > 3months were included. Bipolar highvoltage, long-duration PRF at 42°C for 900 seconds was applied after the induction of paresthesias covered the regions of hyperalgesic skin. The therapeutic effects were evaluated using a visual analog scale (VAS) and the 36-item Short Form health survey (SF-36) before treatment and one, 4, 8, and 12 weeks after PRF. Results: The VAS scores at one, 4, 8, and 12 weeks after PRF treatment were significantly lower than before treatment (P < 0.001). The SF-36 scores, which included physical functioning, physical role, bodily pain, general health perceptions, vitality, social function, emotional role, and the mental health index, were significantly improved up to 12 weeks after PRF treatment (P < 0.001). No serious adverse effects were identified following treatment. The main adverse reactions included pain, tachycardia, and high blood pressure (especially when the field strength was enhanced). Limitations: Single center study, relatively small number of patients, lack of a control group. Conclusion: Bipolar high-voltage, long-duration PRF on the DRG is an effective and safe therapeutic alternative for PHN patients. This treatment could improve the quality of life of PHN patients. Clinical Trial Registration: NO ChiCTR-OCS-14005461 Key words: Pulsed radiofrequency, postherpetic neuralgia, VAS, SF-36

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Electrical Modulation Of Pain: Gene Modulation Using Both Pulsed Radiofrequency And Spinal Cord Stimulation

10.30707/etd2015.tilley.d ◽

2015 ◽

Author(s):

Dana M. Tilley

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pulsed Radiofrequency ◽

Gene Modulation ◽

Electrical Modulation

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

Pain Management ◽

10.2217/pmt-2020-0016 ◽

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.

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Efficacy of Pulsed Radiofrequency in the Treatment of Thoracic Postherpetic Neuralgia from the Angulus Costae: A Randomized, Double-Blinded, Controlled Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/15 ◽

2013 ◽

Vol 1;16 (1;1) ◽

pp. 15-25

Author(s):

Wang Yingwei

Keyword(s):

Side Effects ◽

Postherpetic Neuralgia ◽

Sham Group ◽

Bodily Pain ◽

Energy Output ◽

Radiofrequency Energy ◽

Pulsed Radiofrequency ◽

Number Of Patients ◽

Sf 36 ◽

Double Blinded

Background: Postherpetic neuralgia (PHN) is often refractory to existing treatments. Pulsed radiofrequency (PRF) is known to be effective for treating neuropathic pain. In common, the targets of PRF treatment were the segmental dorsal root ganglion (DRG) neurons responsible for the pain. A potential complication that can occasionally occur with PRF treatment is damage to the adjacent tissue and organ. The effectiveness of the angulus costae as a puncture site for PRF has not been tested in thoracic PHN treatment. Objective: The goal of this study was to investigate the therapeutic efficacy and safety of PRF for treating thoracic PHN through the puncture of the angulus costae. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Anesthesiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Methods: Ninety-six patients with thoracic (T2-11) PHN were equally randomized assigned into 2 groups. The electrode needle punctured through the angulus costae of each patient guided by x-ray; PRF at 42°C for 120 seconds was applied after inducing paresthesia involving the affected dermatome area. PRF was applied in the PRF group (n = 48) twice. It was also applied in the sham group (n = 48) twice without radiofrequency energy output. The treatment was done once a week for 3 weeks. Tramadol was used for flare pain when the visual analog scale (VAS) ≥ 3. Outcomes Assessment: The therapeutic effect was evaluated by VAS, SF-36 health survey questionnaire, side effects (type, frequency, and onset time) before treatment, at days 3, 7, and 14, and at months one, 2, 3 and 6 after PRF. The average of tramadol (mg/d) administrated within the first month after treatment was also recorded. Results: The postprocedure VAS scores in the PRF group were significantly lower than those in the sham group and lasted for 6 months after treatment (P < 0.05). The SF-36 score, such as physical functioning, physical role, bodily pain, general health perceptions, social function, emotional role, and mental health index were significantly improved until 6 months after treatment in the PRF group compared to the sham group (P < 0.01-0.05). The average dosage of tramadol administered (mg/d) within the first month after treatment was also significantly reduced in the PRF group compared to the sham group (P < 0.05). There were no obvious signs of pneumothorax, bleeding, infection, or other severe side effects in either group (P > 0.05). Limitations: Single center study, relatively small number of patients. Conclusions: The strategy that the angulus costae be used as the PRF puncture point of an electrode needle and the final localization of the needle tip as determined by sensory testing is an effective and safe therapeutic alternative for thoracic PHN treatment. Benefits include that the procedure is minimally invasive, provides short-term pain relief, and improves quality of life. Clinical Trial Registration: NO ISRCTN25588650. Key words: Thoracic, postherpetic neuralgia, pulsed radiofrequency, angulus costae

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