Sustainable Effects of 8-Year Intermittent Spinal Cord Stimulation in a Patient with Thalamic Post-Stroke Pain

Central post-stroke pain (CPSP) is a central neuropathic pain syndrome secondary to a cerebrovascular accident. CPSP treatment usually begins with medication; however, this is associated with inadequate pain relief and adverse effects. Neurostimulation therapies, including spinal cord stimulation (SCS), have been developed for improved pain relief. We report a patient with thalamic pain who underwent 8-year cervical SCS in an intermittent mode.

A 71-year-old man presented with left thalamic stroke that caused persistent allodynia and "pricking" sensations at right-side extremities. The pain did not respond well to several pain therapies, including medication, acupuncture, and nerve-blocking anesthesia. Subsequently, the severe and refractory pain caused dystonia in his right hand and seriously hindered recovery and rehabilitation of stroke sequelae. Further, the pain induced depression and severe anxiety mood status and had an effect on his functional activities of life. After SCS device implantation, the patient received intermittent stimulation with 90 minutes on/30 minutes off. A significant decrease in the patient's pain was observed with no serious side effects. After subtle programming of the implantable pulse generator, a significant improvement of his dystonia and affective mood was observed. Intermittent SCS allowed for persistent stimulation for 8 years. Taken together, this intervention allowed for an acceptable improvement of his functional quality of life.

Our findings indicate that SCS is safe and efficacious for CPSP, including thalamic stroke pain. Long-term intermittent stimulation can preserve implantable pulse generator battery life and achieve sustained improvement of a patient's pain, movement, and affective mood status.