Spinal Cord Stimulators in Neuropathic Pain. Introduction Chronic pain is very common Immense...
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- Spinal Cord Stimulators in Neuropathic Pain
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- Introduction Chronic pain is very common Immense physical,
psychological, societal impact Financial burden
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- Neuropathic pain Damage or dysfunction of the nervous system
Typical symptoms - burning - shooting - allodynia -
hyperalgesia
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- 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
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- Case history (1) Investigations - MRI - Nerve conduction
studies - Electromyography Diagnosis - Brachial plexus injury
Conservative management strategy EMG
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- 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
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- Case history (1) SCS inserted 2013
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- 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
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- 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
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- Case history (2) SCS inserted 2013
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- Management of chronic pain
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- Neuromodulation Therapeutic alteration of the nervous system
Electrical or pharmacological Implanted devices
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- Gate control theory of pain
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- Gate control theory and spinal cord stimulators
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- History of spinal cords stimulators
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- Which patients might be suitable for a SCS? Failed back surgery
syndrome CRPS Peripheral neuropathy Ischaemic limb pain Angina
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- SCS electrodes
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- Components of the SCS
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- Phases of SCS implantation 1. Assessment phase - appropriate
pathology - appropriate patient 2. Trial phase 3. Implantation
phase
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- Where are the electrodes placed? Upper extremity T1-T2 Low back
T8-T10 Lower extremity T10-T12
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- Trial phase
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- What are the criteria for a successful trial? 50% pain Area of
parasthesia = area of pain Parasthesia not unpleasant Functional
improvement
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- Complications of SCS Additional revision of the device (23%)
Hardware malfunction (10%) Infection (4.6%) Complications during
insertion
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- Some issues for patients.
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- NICE Guidelines
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- 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
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- Case history (2) Failed back surgery syndrome 2 months later
VAS scores 10 2 Improved mobility Reduced analgesic medications
Improved mood
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- 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
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- Thank You