Case Studies in Pain Management: Spinal Cord Stimulation

Case Studies in Pain Management:Management: Spinal Spinal Cord Cord Stimulation Stimulation

Patient history the treatment plan to also feature medial ing failed back syndrome and other select branch blockade injections, lumbar medial chronic pain disorders such as complex Conservative management was what a branch blocks and lumbar radiofrequency regional pain syndrome (Types I and II) and local orthopedic surgeon had in mind for low back denervation. Relief was achieved peripheral neuropathy. his patient – a debilitated 66-year-old male with each of these interventions but, alas, suffering chronic low back pain – when Since mental health status affects respon- the effects did not last long enough for us he entrusted the retired electrical techni- siveness to spinal cord stimulation, we to be able to declare success. cian into our care. Specifically, the doctor require each implant candidate to first saw conservative management as the only Next, we evaluated the patient as a undergo psychological screening to help viable option for the patient after earlier potential candidate for implantation of a us determine his or her suitability for having determined him to be an inappropri- spinal cord stimulator. After determining receiving the device. Moreover, psycho- ate candidate for surgery. him to be a strong candidate to receive logical screening helps us ascertain one, we ordered a trial of the device. The whether the candidate is competent to Case description patient responded remarkably well to the operate the patient-controllable spinal cord The patient presented to us with signs of device during the three-day trial period. stimulator. lumbar spondylosis. This was confirmed by Arrangements were made to permanently Preoperative trialing of the spinal cord both MRI and nerve conduction EMG stud- implant it. The spinal cord stimulator was stimulator involves a minimally invasive ies (although the two tests contradicted successfully implanted in June 2008. procedure in which the device’s electrode one another as to whether there was or lead wires are placed at targeted locations wasn’t associated nerve impingement – Outcome in the epidural space while the patient is MRI hinted no, EMG suggested yes). Pain relief from the spinal cord stimula- under conscious sedation. (Keeping the tor was substantial – so much so that we During our workup, we learned that the patient awake allows him or her to sup- were able to stop both the injections patient had been taking low-dose opioid ply verbal feedback that helps determine and medications. The patient has largely medication as prescribed by the referring the optimal lead placement positions.) regained his functional abilities and now physician. However, the patient reported The main components of the device – a conducts his life with virtually no restric- gaining scant relief from it. Moreover, radiofrequency receiver, a microprocessor tion on activities. unpleasant side effects led to his pressing unit and their power source, all encased in us to discontinue prescribing it for him. a shell approximately the same dimensions Discussion as a silver dollar – remain external for the Treatment plan Spinal cord stimulation is an effective – duration of the trial period and are only albeit overlooked – treatment for severe implanted subcutaneously if spinal cord The patient was started on a program of chronic pain. It is FDA-approved and has stimulation passes this effectiveness test. conservative management that included been around since the 1940s, with over different and better pain medications in 100,000 patients currently experiencing tandem with therapeutic exercise, ad- pain relief because of it. Studies dating equate rest and control of anxiety. When back to the 1990s have demonstrated the these measures fell short of providing the efficacy of spinal cord stimulation in reliev- hoped-for level of pain relief, we amended

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