Abstract
Chronic axial low back pain (LBP) is one of the most common ailments in the United States, with a significant impact on quality of life and function. Multimodal therapy is often utilized for pain relief, including opioid pain medication. Current indications for spinal cord stimulation include chronic neuropathic conditions, such as failed back surgery syndrome, radiculopathies, complex regional pain syndrome types I and II, postherpetic neuralgia, and peripheral diabetic neuropathies. While current lead placements perform remarkably when used for their appropriate indications, there is no specific indication for spinal cord stimulation in the treatment of axial LBP. However, spinal cord stimulation lead placement at the T6 mid-vertebral body can be considered in patients with significant or predominant complaints of axial LBP. Achievement of pain relief via spinal cord stimulation can reduce the administration of both opioid and non-opioid pain medications.
Highlights
Chronic pain, especially low back pain (LBP), is one of the leading causes of physical activity limitation, absence from work, and disability globally
In the United States alone, the economic impact of workdays lost secondary to LBP has been estimated at 100-200 billion USD each year [2]
Chronic axial LBP can be challenging to treat in many patients
Summary
Especially low back pain (LBP), is one of the leading causes of physical activity limitation, absence from work, and disability globally. The first spinal cord stimulators (SCS) were designed based on the gate control theory initially proposed by Melzack and Wall in 1965 [1,3]. The patient reported progressively worsening pain secondary to a motor vehicle accident in 2016 She responded well to medical management, and the radicular component of the pain was controlled. In May 2021, the patient reported significant worsening of left lower extremity complaints and emergence of right lateral thigh pain She was started on baclofen 10 mg BID, pregabalin 100 mg BID, and Percocet 5/325 mg BID with minimal relief. On follow-up three days later, the patient reported total resolution of her radicular pain, as well as 85% resolution of her axial LBP She noted that she had not taken Percocet or baclofen the past two days due to the extent of her pain relief. At the time of this publication, the patient is awaiting placement of a permanent SCS implant and will continue on medication management
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