Affiliations: Department of Pain Medicine, St. James's Hospital and Institute of Neuroscience, Trinity College Dublin, Ireland
Correspondence:
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Corresponding author: Hari Gopal, Department of Pain Medicine, St. James's Hospital and Institute of Neuroscience, Trinity College Dublin, Ireland. Tel.: +353 87 2181697; E-mail:doc_harigopal@yahoo.com
Abstract: BACKGROUND: Spinal cord stimulation (SCS) is used for the treatment
of chronic neuropathic pain, a notoriously difficult condition to treat.
Failed Back Surgery Syndrome (FBSS) and Complex Regional Pain syndrome
(CRPS) remain the strongest indications. Funding remains a difficult issue
and the use of trial of stimulation is the traditional method of ensuring
best outcomes from implantation. METHODS: A retrospective and consecutive review of 80 cases of
spinal cord stimulation for patients with a diagnosis of FBSS and CRPS
having undergone prior comprehensive medical management and interventional
treatment with no sustained benefit. Trial of stimulation was performed
on-table and if acceptable coverage was achieved, the case proceeded to full
implantation. RESULTS: The mean patient age was 50.08 years (range 28-80 years).
At 12 months follow-up, thirty two patients (40%) no longer required
analgesic medication. Thirty patients (37.5%) reported their pain was
manageable with first line analgesics. Fourteen (17.5%) reported their
pain was manageable first line analgesic and occasional tramadol or codeine.
Four (5%) reported that their pain was manageable with NSAID's,
paracetamol, amitriptyline, and regular codeine or tramadol. Seventeen out
of eighty patients (21.25%) were unemployed before SCS implant, and at 12
months follow up eight of these patients (47.05%) had returned to work.
There was no infective complications or explants. Two patients (2.53%)
required one lead revision, which was successful. CONCLUSION: SCS is the most effective treatment for FBSS and CRPS,
which is proven resistant to medical management. On-table trial and
implantation is easy to perform with good success rate and low morbidity and
if successful will reduce complication rates, especially infection.
