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Spinal Cord Stimulators in Neuropathic Pain

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

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Spinal Cord Stimulators in Neuropathic Pain

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  1. Spinal Cord Stimulators in Neuropathic Pain

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

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

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

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

  6. 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

  7. Case history (1) SCS inserted 2013

  8. 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

  9. 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

  10. Case history (2) SCS inserted 2013

  11. Management of chronic pain

  12. Management of chronic pain

  13. Management of chronic pain

  14. Management of chronic pain

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

  16. Gate control theory of pain

  17. Gate control theory and spinal cord stimulators

  18. History of spinal cords stimulators

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

  20. SCS electrodes

  21. SCS electrodes

  22. Components of the SCS

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

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

  25. Trial phase

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

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

  28. Some issues for patients….

  29. NICE Guidelines

  30. Case history (1) Complex regional pain syndrome4 months later • VAS scores 10  3 • Some restoration of hand function • Reduction in analgesic medication • Improved mood

  31. Case history (2)Failed back surgery syndrome2 months later • VAS scores 10  2 • Improved mobility • Reduced analgesic medications • Improved mood

  32. 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

  33. Thank You

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