057 Neuropathic pain in multiple sclerosis: impact of spinal cord stimulation, an under-utilised modality?

Abstract

<h3>Introduction</h3> Neuropathic extremity pain is reported in 26% (95% CI 7-53%) of patients with multiple sclerosis (MS),¹ causing significant morbidity. Evidence for pharmaceutical management is limited and medications may cause prominent adverse effects. Spinal cord stimulation (SCS) is an effective treatment for central neuropathic pain and has demonstrated efficacy in MS.^2–4 Limitations to use include lack of awareness, expense and the consequent inability to perform MRI for MS surveillance.⁴ <h3>Methods</h3> We report four patients from a regional MS clinic with refractory neuropathic pain referred for SCS. Quality of life scores using the multiple sclerosis impact scale (MSIS-29) and medications requirements prior to SCS and at most recent review were assessed. <h3>Results</h3> Four female patients, aged 48 to 55, were referred for SPS. All patients had a positive response to trial stimulation and proceeded to SCS implantation. Mean MSIS-29 score was 101/145 (range 91–121) prior to SCS and 54.5/145 (range 40-83) at most recent review. Three patients were able to reduce or cease analgesic medications. There was no associated operative morbidity. <h3>Conclusions</h3> Three of the 4 patients in this series with refractory neuropathic pain experienced significant improvement in quality of life, measured by MSIS-29, after SCS implantation and were able to reduce or discontinue analgesic medications. SCS is a potentially effective treatment for refractory neuropathic pain in MS however is under-utilised for this indication. These 4 individuals, identified from a regional MS service, represent the only MS patients referred to this tertiary pain centre in recent year for consideration of SCS. <h3>References</h3> Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, <i>et al</i>. Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. <i>Pain</i> 2013;154(5):632–42. Kumar K, Nath R, Wyant GM. Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. <i>Journal of Neurosurgery</i> 1991;75(3):402. Provenzano DA, Williams JR, Jarzabek G, DeRiggi LA, Scott TF. Treatment of neuropathic pain and functional limitations associated with multiple sclerosis using an MRI-compatible spinal cord stimulator: a case report with two year follow-up and literature review. Neuromodulation: Technology at the Neural Interface 2016;19(4):406–13. Abboud H, Hill E, Siddiqui J, Serra A, Walter B. Neuromodulation in multiple sclerosis. <i>Multiple Sclerosis Journal</i> 2017;23(13):1663–76.