Italian Multicentric Study on Pain Treatment with Epidural Spinal Cord Stimulation

Abstract

A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. The diagnosis was failed back surgery syndrome in 45%, reflex sympathetic dystrophy in 15%, phantom limb pain in 14%, postherpetic neuralgia in 8%, peripheral nerve injury in 5%, others 13%. 84% received noninvasive unsuccessful treatment (10 tensor acupuncture). All had previous pharmacological therapy which was not always discontinued when SCS took place. Pain assessment had been done with the visual analog scale and verbal scale both subjectively and by the physician and nurses. Neuropsychological profile with minimal mental test or MMPI was obtained in 68% of the patients. These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.

Spinal Cord Stimulation for the Treatment of Refractory Unilateral Limb Pain Syndromes

“…In our study, the initial response rate of 87% dropped to 79% at 6 months but improved to 84% at 2 years due to a committed follow-up and maintenance program. Our complication and explantation rates were similar to previously published data [2,3]. If an SCS therapy program does not yield an initial response rate after implantation of at least 80% and a long-term effectiveness of 80% of the responders at 2-3 years, the tangible benefits of SCS could be lost and this therapy may become difficult to justify.…”

“…However, at 14-48 months, only 80% continued to have pain relief [1]. Another study demonstrated that the initial 87% success rate at 3 months dropped to 75% at 6 months, down to 69% at 12 months and to 58% at 24 months [3]. In our study, the initial response rate of 87% dropped to 79% at 6 months but improved to 84% at 2 years due to a committed follow-up and maintenance program.…”

Spinal cord stimulation in the treatment of failed back surgery syndrome

“…This method makes it difficult to determine how effective the stimulator was in treating the painful conditions. Some of these shortcomings were avoided by a large, multicenter Italian study published by Broggi et al [6]. They retrospectively report on the experience of 32 centers treating 410 patients with chronic pain.…”

Subcutaneous stimulation as additional therapy to spinal cord stimulation in a post-laminectomy syndrome patient

“…[6][7][8][9][10] Yapılan çalışmalar, kronik ağrı tedavisinde spinal kord stimülasyonu uygulamasının güvenli ve efektif olduğunu göstermiştir. [11,12] Bu yazıda lumbar disk hernisi nedeniyle operasyon geçiren ve sonrasında postlaminektomi sendromu gelişen ve SKS uygulanmasına rağmen sağ kalça ve bel bölgesinde ağrı şi-kayeti devam eden hastaya sağ kluneal sinir dağılım bölgesine oktad elektrod'un subkutan (SUBQ) olarak yerleştirildiği hastadan bahsedilmektedir. Kliniğimiz-de ilk defa uyguladığımız SKS ve SUBQ kombinasyonu ile elde ettiğimiz başarılı sonuçtan sözedeceğiz.…”