Peripheral subcutaneous field stimulation for the treatment of spinal cord injury at-level pain: case report, literature review, and 5-year follow-up

Abstract

Spinal cord injury (SCI) frequently engenders chronic pain which may be classified as occurring above, at, or below the level of injury. Since patients with SCI may have a complex combination of nociceptive and neuropathic pain, pharmacological interventions often fail. Peripheral subcutaneous field stimulation (PSFS) is a novel neuromodulation surgery for pain in which subcutaneous electrodes designed for spinal cord stimulation are placed subcutaneously in a region of pain. We report the case of a 26-year-old man who was an unrestrained driver in a motor vehicle accident and suffered a complete ASIA A spinal cord injury with paraplegia due to a T4 three-column burst fracture. He underwent successful surgical fixation of the fracture (7/27/12) and developed severe at-level SCI-associated pain which failed all conservative measures. After a successful trial, two octrode leads (Abbott Medical, Plano, TX, USA) were placed for PSFS under general anesthesia and were connected to a right flank rechargeable pulse generator (11/6/13). At 60 months postoperative, the patient continues to use the peripheral field stimulation system on a daily basis and reports near complete relief of his at-level spinal cord injury pain. He noted instantaneous relief of his pain once ideal stimulation programming was achieved and has tolerated complete cessation of all narcotic use. His current programming settings are: Frequency of 50 Hz (Hz), Pulse Width of 350 μs (μsec), Amplitude of 0.00 miliamps (mA), Comf of 7.70 mA, and Perc of 4.50 mA. Chronic pain is a challenging and expensive sequela to manage in SCI patients and newer therapies are needed. Our case suggests that SCI at-level pain may respond durably to PSFS and provides the longest published follow-up on a case of PSFS. Peripheral subcutaneous field stimulation remains an investigational treatment for chronic pain syndrome and larger, long-term follow up studies are needed for the FDA and payers to approve this modality.

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

“…Functional electrical stimulation of permanently denervated muscle is also effective and can preserve muscle quality and function [144]. In addition, electrical stimulation can improve neuroplasticity and reduce systemic complications [145,146] and improve pain relief, trunk stability, and motor function [147][148][149]. Use of a brain-computer interface and artificial nerve prostheses can help paralyzed patients carry out activities of daily living and promote neural remodeling [150][151][152].…”

The 2020 Yearbook of Neurorestoratology

“…Using the closed-loop demultiplexing BCI, he regained ability to detect touch and significantly improved several sensorimotor functions [ 32 ]. A patient with SCI at-level pain was treated by peripheral subcutaneous field stimulation (PSFS) during 5-year follow-up, which may be the longest published follow-up of PSFS therapy [ 33 ]. In a patient with severe refractory neuropathic pain and sensory impairment, high-frequency spinal cord stimulation (SCS), considerably reduced his pain [ 34 ].…”