Management of Intractable Pain with Percutaneous Epidural Spinal Cord Stimulation

Abstract

This study is a survey of the overall clinical results achieved with our pain treatment method, percutaneous epidural low-frequency (1.6-8.0 Hz) spinal cord stimulation. It examines the relationship between the effectiveness of epidural spinal cord stimulation (ESCS) and diseases or sites of pain. Continuous indwelling of the catheter electrodes in the posterior epidural space ranged from 3 to 67 days, and the duration of percutaneous ESCS varied from less than 1 wk to more than 1 yr. Complete pain relief (100%) was achieved during stimulation in 11.5% of the patients (52 of 454). Complete (100%) to partial (more than 30%) pain relief occurred in 71.1% of the patients. In six (1.3%) patients pain was aggravated by stimulation. Analgesics and/or sedatives were discontinued completely after treatment in 52 patients (11.5%) and reduced in 263 patients (57.9%). The number of patients who rated pain relief better than 50% was significantly more in carcinoma/sarcoma and causalgia (P < 0.001), and significantly less in postherpetic neuralgia and thromboangitis obliterans/arterial sclerosis obliterans (P < 0.001) than the average in all diseases. There was a significantly high responsiveness to ESCS in female patients in comparison to male patients (P < 0.05). Pain in the head/face, neck/upper extremities, and trunk responded more to ESCS than pain in the lower extremities. Alleviation of pain by ESCS was lower when the verbal pain score was high. There were no major complications in percutaneous ESCS. Thus, we have demonstrated that pain-alleviating effects of ESCS varies significantly by disease and site of pain, and that this simple percutaneous method can be used for a relatively long period.

Neuromodulation: Spinal cord and peripheral nerve stimulation

“…Local and systemic infections have also been reported in the literature and anecdotally [33,35,36]. Local skin infections can be treated with oral antibiotics and local wound care.…”

“…As the procedure evolved, the epidural space became the preferred site for electrode placement. Current complications include CSF leaks, seroma formation, and lead migration, but are much less common because the dura is not intentionally punctured during epidural insertion [5,33,[35][36][37]. Electrode migration commonly occurs during the first month post-insertion, probably before fibrous tissue is able to form around the electrode to help secure it in place [36].…”

“…This includes electrode fracture, faulty pulse generators and radiofrequency receivers, extension cable breakage, and "leaky" connectors [33,35,36,[38][39][40]. These complications are easily treated by replacement of the problematic component.…”

Recent advances in cancer pain management

“…The most significant case series was performed by Shimoji et al [53]. This was a retrospective analysis of 454 patients with spinal cord stimulators, of which 52 had cancer pain.…”

Four-Decade Maintenance of Analgesia with Percutaneous Cordotomy

“…The reasons for this asymmetric patient selection are 2-fold. First, for patients with noncancer pain syndromes and normal life expectancy, alternative nonablative pain therapies exist, such as spinal cord stimulation or intrathecal opioid delivery [10,11,12]. Second, while the persistence of analgesia following percutaneous cordotomy has been well-demonstrated in patients with cancer-related pain and shortened life expectancy, evidence of long-term analgesia has been lacking.…”