Spinal cord stimulation relieves nonspecific limb pain

[Wise Young]

Published on 04/19/2001

Clinical

Spinal cord stimulation relieves nonspecific limb pain

Last Updated: 2001-04-19 17:00:23 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) - Spinal cord stimulation (SCS) is an effective means of alleviating limb pain that is not obviously neuropathic in origin, according to a report published in the May issue of Neurosurgery.

Dr. Seong H. Kim, from Yeungnam University in Taegu, Korea, and colleagues assessed the pain-relieving effects of SCS in 74 patients with chronic limb pain who underwent permanent electrode implantation. All subjects had previously responded to a trial of a monopolar epidural electrode.

A monopolar, quadripolar, or Resume quadripolar electrode was implanted in 19, 53, and 2 patients, respectively. Patients were followed for an average of 3.9 years. Successful SCS was defined as >50% reduction in pain for 1 year.

Treatment was unsuccessful in 20.3% of patients within 1 year of implantation and in 33.8% of patients after 1 year, the authors note. At latest follow-up (mean 4.1 years, range 1.3 to 9 years), 45.9% of patients were continuing to receive SCS.

SCS was successful in 83.3%, 89.5%, and 73.9% of subjects with nonspecific leg pain, limb pain with root injury, and neuropathic pain, respectively. SCS was more effective in controlling spontaneous pain associated with neuropathic pain syndromes than in controlling allodynia or hyperpathia. Surgical revision was needed less often when a quadripolar rather than a monopolar electrode was implanted.

"SCS is as effective in treating nonspecific limb pain as it is in treating neuropathic pain of nerve root origin," the researchers state. "Our results demonstrate that evoked pain is less responsive than spontaneous pain to SCS, which likely reflects the different pathways involved in the two types of pain."

Neurosurgery 2001;48:1056-1065.

[Wise Young]

Published on 04/19/2001

Spinal cord stimulation offers pain relief

NEW YORK, Apr 19 (Reuters Health) - Spinal cord stimulation--sending small electrical pulses into the spine--offers relief for a variety of painful conditions, researchers report.

Spinal cord stimulation (SCS) has been used for decades to treat chronic pain, but few studies have analyzed its effectiveness for other types of pain, according to Dr. Seong Kim from Yeungnam University in Taegu, Korea and colleagues.

If successful, SCS produces a feeling of numbness that overcomes the sensation of pain. The process requires an electrode and stimulator that can be permanently implanted.

The authors reviewed their results with SCS in 122 patients with different pain syndromes including nerve injuries, damage to the spinal cord and even people with no demonstrable cause for their pain. The findings were reported in the May issue of Neurosurgery.

Overall, about 64% of patients had a successful trial of SCS, and 74 elected to have a permanent stimulator implanted, the authors report. Despite a successful trial of SCS, 20% of patients had no significant pain relief after the stimulator was surgically implanted, the results indicate. Another 34% initially had pain relief, but the pain returned after at least a year.

That left 46% of patients who were still using their stimulators an average of 4 years after implantation. According to the researchers, 21% of these patients rated their pain relief as excellent, 50% as good, and 29% as fair.

After looking closer at their results, the investigators say that pain relief with SCS did not differ for the various types of pain, and results were the same for patients regardless of age, sex, number of previous back operations, or length of pain before their SCS implant.

Complications were few, the report indicates, though 20% of the stimulators had to be removed for one reason or another, ranging from infection to device failure.

Based on their findings, the authors conclude that SCS can be a safe and effective treatment for chronic pain regardless of its cause.

SOURCE: Neurosurgery 2001;48:1056-1065

[alan]

Unfortunately, it didn't work on this patient. :-(