Abstract
Introduction: Collecting a patient’s pain scores and the analgesic effect achieved during spinal cord stimulation (SCS) trials can be difficult, and no standard exists for doing so. We propose a topographical mapping tool that was derived from a patient’s perspective. Case: A 60-year-old man with postherpetic neuralgia (PHN) underwent a SCS trial after conservative treatment failed to relieve his pain. During the SCS trial, with the SCS off and on in five different settings, he recorded pain levels in each of the six different painful zones he identified. The data collected were transferred to a topographical and anatomical map, which helped the physicians to better understand the effects of the SCS at different settings. Ultimately, the data collected by the patient helped the physicians to implant a permanent SCS successfully. Conclusions: Patient pain diaries have been used in pain medicine for years. This particular patient’s collection of pain scores and SCS effects inspired the construction of a more standardized tool for collecting such data during SCS trials. We propose that use of our Topographical Anatomical Neuropathic-pain Guided (TANG) mapping tool will enable physicians to choose SCS lead positions more precisely than is currently possible.
Highlights
Collecting a patient’s pain scores and the analgesic effect achieved during spinal cord stimulation (SCS) trials can be difficult, and no standard exists for doing so
We propose that use of our Topographical Anatomical Neuropathic-pain Guided (TANG) mapping tool will enable physicians to choose SCS lead positions more precisely than is currently possible
A patient with postherpetic neuralgia (PHN) inspired us to change our approach to dealing with neuropathic pain and spinal cord stimulation (SCS), a form of neuromodulation
Summary
Highly descriptive, well demarcated, and precisely detailed feedback from a patient can greatly facilitate the ability of healthcare practitioners to understand the complexity of neuropathic patterns and the potential analgesic benefit from neuromodulation. PHN is dermatomal in nature [1], some patients with PHN can have multiple different pains, dysesthesias, and hyperalgesia simultaneously, each with its own specific nature and sub regions that may extend beyond the boundaries of the original herpes zoster rash regions [2] Such chronic pain patterns can have detrimental effects on social and psychological functioning and adversely affect quality of life [3]. The approach of ascertaining maximal information regarding the patient’s specific experiences during the trial week is invaluable Such knowledge makes future implantation and reprogramming sessions much more likely to capture optimal and effective SCS coverage where it counts the most—namely what the patient feels is most analgesic and beneficial to his or her quality of life
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