Abstract
Spinal cord stimulation (SCS) is an effective treatment for chronic back and limb pain. The criteria for use of SCS for specific problems such as failed back surgery syndrome (FBSS), peripheral neuropathic pain and residual pain after joint replacement is well established. With an aging population, there are more patients presenting with a combination of various multi-factorial chronic pain problems rather than from a single clear cause. It is not uncommon to see patients with chronic back pain years after spine surgery with new additional pain in the area of joint replacement or due to peripheral neuropathy. In most of these patients, one area is the primary cause of their pain, while the other more secondary. Multiple chronic problems complicate the pain management of the primary cause and also can diminish the effect of SCS that only targets the primary problem. The primary and secondary causes of pain were ranked by the patient including the duration of their chronic pain for each area. This helped establish criteria for use of SCS in these complex pain patients. The patients were evaluated initially with an epidural stimulator trial and if they obtained 50% or greater pain relief to the primary pain generating area, permanent implantation of one or more arrays of spinal cord electrodes was performed but planned to cover also the secondary pain areas. Post-implant follow-up evaluation at one, three and six months included measurement of visual analog scale (VAS), use of pain medication and degree of functional activity and behavior. This report looks at the effectiveness of using multiple overlapping electrodes for SCS in patients with multi-factorial chronic pain.
Highlights
In reviewing a series of patients being evaluated for a trial of spinal cord stimulation for pain control of chronic back pain after lumbar surgery and a group of patients with multiple lumbar vertebral fractures, a number of patients were identified that had non-radiating limb pain that was distinct from residual sciatic radicular pains
21 patients were evaluated with spinal cord stimulation with temporary trials and 17 underwent subsequent permanent implantation of a spinal cord stimulator with one or two leads
Patients presenting with chronic back pain and limb pain after spinal surgery can have lower extremity pain from residual sciatica, but the pain can be related to peripheral neuropathy
Summary
In reviewing a series of patients being evaluated for a trial of spinal cord stimulation for pain control of chronic back pain after lumbar surgery and a group of patients with multiple lumbar vertebral fractures, a number of patients were identified that had non-radiating limb pain that was distinct from residual sciatic radicular pains. These patients, besides axial lumbar pain, had concurrent problems secondary to painful diabetic or vascular peripheral neuropathy or chronic pain from hip or knee replacement. The left knee pain was dull but significantly worse with weight bearing, standing and walking
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