Spinal Cord Stimulators in Neuropathic Pain. Introduction Chronic pain is very common Immense physical, psychological, societal impact Financial burden.

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Presentation transcript:

Spinal Cord Stimulators in Neuropathic Pain

Introduction Chronic pain is very common Immense physical, psychological, societal impact Financial burden

Neuropathic pain Damage or dysfunction of the nervous system Typical symptoms - burning - shooting - allodynia - hyperalgesia

Case history (1) Mr X - Referred to the pain clinic PC - Right arm pain Hx PC - Day 1 post medical procedure - Tingling, weakness, numbness of right arm

Case history (1) Investigations - MRI - Nerve conduction studies - Electromyography Diagnosis - Brachial plexus injury Conservative management strategy EMG

Case history (1) Follow up at 6 weeks - Burning, painful to touch, skin discolouration Diagnosis - Complex regional pain syndrome (CRPS) Therapies in pain clinic - Neurogenic pain medications - Cervical sympathetic block

Case history (1) SCS inserted 2013

Case history (2) Mr FF, 62 yrs - GP referral to pain clinic PC - Back pain radiating to both legs Hx PC - 20 year history of back pain - Physiotherapy/analgesia - Multiple surgical procedures

Case history (2) Diagnosis - “Failed back surgery syndrome” Therapies in pain clinic - Neurogenic pain medications - Epidural and facet joint injections - L5/S1 nerve root block

Case history (2) SCS inserted 2013

Management of chronic pain

Neuromodulation Therapeutic alteration of the nervous system Electrical or pharmacological Implanted devices

Gate control theory of pain

Gate control theory and spinal cord stimulators

History of spinal cords stimulators

Which patients might be suitable for a SCS? Failed back surgery syndrome CRPS Peripheral neuropathy Ischaemic limb pain Angina

SCS electrodes

Components of the SCS

Phases of SCS implantation 1. Assessment phase - appropriate pathology - appropriate patient 2. Trial phase 3. Implantation phase

Where are the electrodes placed? Upper extremity T1-T2 Low back T8-T10 Lower extremity T10-T12

Trial phase

What are the criteria for a successful trial? 50%  pain Area of parasthesia = area of pain Parasthesia not unpleasant Functional improvement

Complications of SCS Additional revision of the device (23%) Hardware malfunction (10%) Infection (4.6%) Complications during insertion

Some issues for patients….

NICE Guidelines

Case history (1) Complex regional pain syndrome 4 months later VAS scores 10  3 Some restoration of hand function Reduction in analgesic medication Improved mood

Case history (2) Failed back surgery syndrome 2 months later VAS scores 10  2 Improved mobility Reduced analgesic medications Improved mood

Conclusion Neuropathic pain is common, some patients are refractory to standard therapies Neuromodulation is an alternative method for treating severe, intractable pain Excellent results can be achieved with selected patients

Thank You