Chapter 73 - Spinal Cord Stimulation for Gastrointestinal Painful Disorders

Abstract

This chapter focuses on the use of spinal cord stimulation (SCS) for gastrointestinal painful disorders. SCS for abdominal and pelvic visceral pain is a new and exciting therapeutic option for the millions of people who suffer from severe visceral pain. It uses low energy current to deliver an electrical field to the spinal cord to modulate efferent pain signals. It remains unclear to this day whether neural modulation by SCS, relieving visceral pelvic pain, is operant at the midline dorsal column pathway, however, it is known that interruption of this pathway relieves visceral pelvic pain in cancer patients. Suppression of the sympathetic outflow could also play a significant role in control of the abdominal visceral pain. Currently, studies on the use of SCS for treatment of visceral pain are limited to case reports or case series. There are compelling data suggesting that SCS may decrease pain and improve functional capacity in patients with various visceral chronic pain syndromes. One of the most challenging chronic visceral pain syndromes to treat is the pelvic pain syndrome. The first reported case series on the use of SCS for treatment of visceral pelvic pain were on six female patients with the diagnosis of long-standing pelvic pain secondary to long-standing endometriosis. In this case, the median VAS pain score decreased from 8 to 3 and all the patients had more than 50% pain relief. Pain disability index (PDI), as measurement of patient's functional capacity, improved significantly and the use of opiate also decreased in long-term follow-up.