Treatment of Central Pain Syndrome with use of spinal cord stimulation
Alexander E. Yakovlev, MD, Angela M. Parmentier, APNP • Comprehensive Pain Management of the Fox Valley, SC
820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
IntroductIon:
Central pain syndrome (CPS) is a neurological condition caused by damage to or dysfunction of the central nervous system (CNS). In this case report, the 60 year old male had a complete spinal cord injury at T10, due to a motor vehicle accident 24 years ago, resulting in paraplegia. Following this, he experienced aortic occlusion and underwent bilateral lower extremity above the knee amputation. Patient complains of bilateral phantom limb pain, hip pain, and sacral pain related to a non-healing decubitus ulcer.
Methods:
SCS trial was attempted with entry into the epidural space at L3-4 and L4-5, but because of severe postoperative changes, the leads were unable to be placed further than T12. Unfortunately, no paresthesia was obtained because of spinal cord transection and the trial was discontinued. Four weeks later, the decision was made to proceed with repeat spinal cord stimulator trial with entry at T7-T8 intervertebral space. Two 8 electrode leads were inserted and were positioned at the level of T5-T6 and T7.
Results:
At this lead placement excellent pain relief, including complete resolution of sacrum, phantom limb, and hip pain was obtained. Patient reported considerable pain relief over the two day trial period, and was later implanted with permanent leads and a RestoreSensor rechargeable generator (Medtronic, Inc., Minneapolis, MN).
Usage:
Uses stimulation 24 hours per day.
Pain relief:
Patient reports leg pain was reduced by 100% from baseline.
Satisfaction:
Patient is 100% satisfied with SCS therapy and would recommend to a friend.
Opioid usage:
Patient completely eliminated use of long acting opioids.
Additional Benefit:
Improved healing of debubitus ulcerations after initiation of SCS.
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ConclusIon:
Based on the outcomes observed and its reversible nature, SCS represents an attractive treatment option for patients with central pain syndrome.
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