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Spinal cord stimulation (SCS) in deafferentation pain
M Meglio1, B Cioni, A Prezioso
1Instituto di Neurochirurgia, Università Cattolica, Roma, Italy.
Pacing and Clinical Electrophysiology : PACE
|April 1, 1989
Summary
Spinal cord stimulation (SCS) shows limited long-term effectiveness for deafferentation pain. However, SCS appears effective and stable for post-therapeutic neuralgia, warranting trial in resistant cases.
Area of Science:
- Neurology
- Pain Management
- Neurosurgery
Background:
- Deafferentation pain, including traumatic spinal lesions, peripheral nerve damage, and post-therapeutic neuralgia, presents significant challenges in pain management.
- Spinal cord stimulation (SCS) is a neurostimulation technique often considered for chronic pain conditions.
- The efficacy of SCS for deafferentation pain, particularly post-therapeutic neuralgia, requires further investigation.
Purpose of the Study:
- To retrospectively analyze the effectiveness and long-term outcomes of spinal cord stimulation (SCS) in patients with various types of deafferentation pain.
- To evaluate the stability of pain relief provided by SCS over time in different patient cohorts.
- To determine the potential role of SCS as a treatment option for refractory post-therapeutic neuralgia.
Main Methods:
- Retrospective analysis of 41 patients undergoing spinal cord stimulation (SCS) for deafferentation pain.
- Patient groups included incomplete traumatic spinal lesions, post-therapeutic neuralgia, and root/nerve damage.
- Outcomes assessed included initial pain relief during a test period and sustained relief at a mean 15-month follow-up.
Main Results:
- Initial satisfactory pain relief with SCS was reported by 43.7% of patients with paraplegic pain, 40% with peripheral deafferentation pain, and 66.6% with post-therapeutic neuralgia.
- At 15-month follow-up, sustained pain relief was reported by only 20% of patients in the first two groups.
- In the post-therapeutic neuralgia group, the response rate remained stable, with a mean analgesia of 70%.
Conclusions:
- Spinal cord stimulation (SCS) demonstrates limited long-term efficacy for pain associated with traumatic spinal lesions and peripheral deafferentation.
- SCS provides stable and significant pain relief in a considerable proportion of patients with post-therapeutic neuralgia.
- Percutaneous SCS testing is recommended for all cases of post-therapeutic pain resistant to conventional medical treatments.