Spinal Cord Stimulation For Neuropathic Cancer RelatedThoracic Pain
Alexander E.Yakovlev, Comprehensive Pain Management ofThe Fox Valley, SC, Appleton,Wis.
Beth E. Resch, APNP, Comprehensive Pain Management ofThe Fox Valley, SC, Appleton,Wis.
Sergey A. Karasev, MD, Department of Neurosurgery, Samara Medical University, Samara, Russian Federation
INTRODUCTION
One-third of cancer patients have pain at diagnosis, 10-15% of patients do not achieve acceptable pain relief with opiates and/or adjuvant analgesics. 15-40% of chronic cancer pain has a neuropathic component (1), responding poorly to opioids. Spinal cord stimulation (SCS), an effective treatment for neuropathic pain, has been used to treat intractable cancer pain (2-3).
METHOD
Twelve patients with lung cancer and related neuropathic chest wall pain underwent SCS placement. Patients, 9 males, 3 females, ages 39-58, had surgical and radiation treatment with no evidence of recurrence or metastases. Conservative therapy failed, including intercostal and epidural blocks.Two day trial of 2 percutaneously placed 8-electrode epidural leads (Medtronic Inc., Minneapolis, MN) resulted in greater than 50% pain improvement. Epidural access atT10/T11 orT11/T12 interspace, final lead positionT2-T3 (Figure 1).Two-4 weeks later patients had permanent leads and RestorePRIME non-rechargeable or RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generator implanted.
RESULTS
All patients reported >75%VAS reduction post-implant, were able to decrease/discontinue pain medications, had improved family relationships, were able to return to social/educational activities.Twelve months post-implant, patients continued reporting good pain control (VAS scores 1-3/10) and improved function.
CONCLUSIONS
SCS is a therapeutic alternative for patients with neuropathic cancer related chest wall pain who in the past exhausted conservative treatments. SCS is an important adjuvant treatment which may make its own niche in the therapy algorithm for these patients.
FIGURES
FIGURE 1 FIGURE 2
REFERENCES
1. Berger A, Dukes E, Mercadante S, Oster G. Use of antiepileptics and tricyclic antidepressants in cancer patients with neuropathic pain. Eur J Cancer Care 2005; 15:138-145.
2. Cata JP, Cordella JV, Burton AW, Hassenbusch SJ,Weng H, Dougherty PM. Spinal cord stimulation relieves chemotherapy-induced pain: a clinical case report. J Pain and Symptom Manage 2004; 27:72-78.
3. Hamid B, Haider N. Spinal cord stimulator relieves neuropathic pain in a patient with radiation-induced transverse myelitis. Pain Pract 2007;7:345-347.
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