Treatment of Central Pain Syndrome and Spasticity with Spinal Cord Stimulation (SCS)
Author Block: Alexander E. Yakovlev, Comprehensive Pain Management of The Fox Valley, SC, Appleton, WI; Beth E. Resch, APNP, Comprehensive Pain Management of The Fox Valley, SC, Appleton, WI; Sergey A. Karasev, M.D., Department of Neurosurgery, Samara Medical University, Samara, Russian Federation;
Abstract:
Introduction: Central nervous system lesions may result in central pain, various degrees of motor impairement and spasticity. SCS was often used for spasticity but with introduction of intrathecal baclofen therapy this treatment is not commonly utilized despite several reports describing its beneficial effects for patient with multiple sclerosis, brain and spinal cord lesions.
Methods: Between December 2003 and May 2007, 4 patients with history of spinal cord injury and one patient after the stroke who developed intractable pain and spasticity underwent spinal cord stimulator placement. All of them were males aged from 19 to 76. The patients failed conservative therapy and had no pain relief after epidural or selective nerve blocks. The patients had good muscle strength and ability to ambulate. All patients were not surgical candidates and went through psychological screening. They underwent successful trial of percutaneous placement of two 4 or 8-electrode epidural leads with final leads positioned in thoracic, cervical spine, or both. During the 2 to 4 day SCS trial the patients reported greater than 50% improvement in pain and had significant reduction of muscle spasms and spasticity. Two later the patients underwent implantation with permanent leads and Synergy non-rechargeable or RestoreADVANCED (Medtronic Inc., Minneapolis, MN) rechargeable generators.
Results:
All patients reported significant pain relief (>50% reduction in VAS) and decreased spasticity with permanent stimulator. The patients were able to decrease or discontinue use of pain medications and also had noticeable improvement of voluntary movements. The clinical effect of SCS lasted at least 12 months.
Conclusions:
SCS may be a treatment option for patients with central pain and spasticity in upper and lower extremities because the stroke or incomplete spinal cord lesions. SCS is a relatively easy to perform, effective, safe and reversible treatment.
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