Ischemic Limb Pain and Chronic Abdominal Pain Treated with Spinal Cord Stimulation: A Case Report
INTRODUCTION
Patients with peripheral arterial disease may suffer from intractable pain and functional incapacitation despite medical therapies and surgical interventions. Control of the pain is even more difficult to achieve if these types of patients have an additional source of pain. Chronic abdominal pain in the patient who exhausted all conventional treatment is also difficult to manage. Spinal cord stimulation (SCS) has been used to treat patients with peripheral vascular disease (1, 2) and the patients with chronic abdominal pain (3). We report combined treatment of ischemic limb and abdominal pain with one SCS system. Ischemic Limb Pain and Chronic Abdominal Pain Treated with Spinal Cord Stimulation: A Case Report
MATERIALS AND METHODS
The patient is a 70-year-old female with history of ischemic leg and chronic abdominal pain who failed in conservative surgical treatment and multiple injections. She underwent a successful trial of percutaneous placement of two 4-electrode and one 8-electrode epidural leads (Medtronic, Inc., Minneapolis, MN). Epidural access was gained at the T12/L1 and L1/L2 interspace with final leads positioned at T6-T7-T8 and T9-T10-T11 (Figure 1). During SCS trial the patient reported greater than 80 percent improvement of the pain and two weeks later underwent placement of PRIME Advanced non-rechargeable generator (Figure 2).
FIGURES
RESULTS
After final implantation the patient had excellent pain relief for 12 months with combined treatment of multi-focal pain. She was able to discontinue
use of all oral pain medications. She had improvement of functional capacity. The patient’s claudication distance increased from less than 30 m to more than 500 m.
CONCLUSIONS
SCS can be an effective option in the management of severe multi-focal pain and lead to functional improvement for patients who have limited medical or nonpharmacologic options.
REFERENCES
1. Ghajar AW, Miles JB. The differential effect of the level of spinal cord stimulation on patients with advanced peripheral vascular disease in the lower limbs. British Journal of Neurosurgery 1996: 12: 402-408.
2. Tiede JM, Huntoon MA. Review of spinal cord stimulation in peripheral arterial disease. Neuromodulation 2004: 7: 168-175.
3. Yakovlev AE, Resch BE. Treatment of intractable abdominal pain patient with Bannayan-Riley-Ruvalcaba syndrome using spinal cord stimulation. WMJ 2009: 108(6): 35-38.
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