Spinal Cord Stimulation for Intractable Visceral Pain due to Chronic Pancreatitis

Abstract

J Korean Neurosurg Soc 46 : [165][166][167] 2009 Pain caused by chronic pancreatitis is medically intractable and resistant to conventional interventional or surgical treatment. We report a case of spinal cord stimulation (SCS) for intractable pain due to chronic pancreatitis. The patient had a history of nonalcoholic chronic pancreatitis and multiple emergency room visits as well as repeated hospitalization including multiple nerve block and morphine injection for 3 years. We implanted surgical lead at T6-8 level on this patient after successful trial of percutaneous electrode. The patient experienced a decreased visual analog scale (VAS) scores for pain intensity and amount of opioid intake. The patient was followed for more than 14 months with good outcome and no further hospitalization. From our clinical case, spinal cord stimulation on intractable pain due to chronic pancreatitis revealed moderate pain control outcome. We suggest that SCS is an effective, noninvasive treatment option for abdominal visceral pain. Further studies and long term follow-up are needed to fully understand the effect of SCS on abdominal visceral pain.

The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases: The Neuromodulation Appropriateness Consensus Committee

“…Currently, there are limited outcomes data on SCS for various chronic visceral pain syndromes. What limited data exist in the literature are in the form of case reports and smaller case series that demonstrate significant clinical improvement in patients with chronic visceral syndromes: mesenteric ischemic pain , esophageal dysmotility , gastroparesis , irritable bowel syndrome (IBS) , chronic pancreatitis , familial Mediterranean fever , posttraumatic splenectomy , generalized chronic abdominal pain , chronic mesenteric ischemia , and chronic visceral pelvic pain . A recent small prospective randomized crossover study on IBS patients receiving SCS demonstrated significant pain relief with SCS .…”

“…Recently, several case series provide some evidence that various causes of chronic abdominal pain and pain from dysmotility syndromes—such as chronic pancreatitis, gastroparesis, mesenteric ischemia, postgastric bypass chronic epigastric pain, and chronic visceral pain after intra‐abdominal surgeries with evidence of abdominal adhesions—could be helped with SCS. A small retrospective study of 35 consecutive patients who underwent SCS trial for chronic visceral pain with clearly defined cause provided some short‐term evidence of the efficacy of SCS .…”

Therapeutic potential of spinal cord stimulation for gastrointestinal motility disorders: a preliminary rodent study

“…neuropathetic pain), the treatment of visceral pain with SCS seems to be a natural extension of its applications. Indeed, a number of studies have demonstrated the therapeutic potential of SCS for the treatment of irritable bowel syndrome and various visceral pain . These studies, along with the two case report studies where SCS was associated with the relief from constipation and the adverse diarrhea symptoms, suggest that the increased GI transit following SCS may be associated with a release from sympathetic inhibition.…”

Spinal Cord Stimulation for Visceral Pain—A Novel Approach

“…Neuromodulation has been used successfully in managing visceral pain . Stimulation also is used in motility disorders of the gastrointestinal tract .…”