Burst spinal cord stimulation for central neuropathic pain

Abstract

Introduction: Central neuropathic pain can result from any type of injury to the central nervous system. Treatment of central neuropathic pain is very challenging. Recently, a novel stimulation paradigm, called burst stimulation, has been presented as an excellent alternative in a group of patients with intractable central neuropathic pain. We report 2 cases where burst spinal cord stimulation (SCS) was applied in patients with neuropathic pain due to spinal cord injury (SCI) or traumatic brain injury. Patient concerns: A 52-year-old man who underwent posterolateral fusion surgery for a T12 bursting fracture after a fall 11 years prior developed disabling pain in the anterolateral part of his right thigh. His neuropathic pain following SCI was refractory to various treatment modalities. A 65-year-old man had complained of intractable, cold, throbbing, and shooting pain mainly in his left lower limb during rehabilitation since undergoing a craniotomy 9 years prior for multiple brain injuries caused by a motorcycle accident. Diagnosis: Both of these 2 cases were diagnosed with central neuropathic pain syndrome caused by SCI or traumatic brain injury. Interventions: Burst SCS were proposed to alleviate the significant refractory pains that were resistant to various medications and stimulation was delivered to the patient in an alternating pattern between traditional tonic and burst waveforms. Conclusion: The efficacy of burst SCS in central neuropathic pain is desirable considering the severity of pain in such patients, the refractory nature of their pain, and the paucity of alternative therapeutic options.

Narrative review of current neuromodulation modalities for spinal cord injury

“…She experienced both reduction in pain frequency and intensity after B-SCS, with effects lasting at 3-month follow up. B-SCS was also utilized in a 52-year old male diagnosed with at-level SCI neuropathic pain having a T12 neurological level of injury with pain localizing to his right anterolateral thigh ( 60 ). Pain intensity and frequency were found to be reduced by half with undiminished efficacy of stimulation at 1-year follow up.…”

Progress in the efficacy and mechanism of spinal cord stimulation in neuropathological pain

“…Recently, a novel mode of stimulation has been proposed as an excellent alternative for the treatment of persistent central nervous pain, namely, sudden stimulation. Yoon and Kim 80 used burst SCS and found that the efficacy of burst SCS in central neuropathological pain is desirable. We all know that new advancements in SCS treatment can provide effective pain relief in patients with chronic pain.…”