Spinal Cord Stimulators in Neuropathic Pain. Introduction Chronic pain is very common Immense...
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Spinal Cord Stimulators in Neuropathic Pain. Introduction Chronic pain is very common Immense physical, psychological, societal impact Financial burden
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
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
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