Pain Management

Spinal Cord Stimulation

Spinal cord stimulation has been used to try to treat intractable pain. The procedure is both expensive and invasive.

Author Year

Country

PEDro Score

Research Design

Total Sample Size

 Methods Outcome
Meier et al. (2015)

Denmark

RCT

PEDro=8

N=14

 Population: Median age=53yr; Gender: males=5, feamles=9; Mean time post injury=79mo; Type of pain: complex regional pain syndrome=5, peripheral neuropathic=9.

Treatment: Individuals were examined during activated and deactivated spinal cord stimulation (SCS), provided in a randomized sequence, via quantitative sensory testing (QST).

Outcome Measures: Pain thresholds (mechanical, thermal, and wind-up-like); Pain intensity; Pain areas.

 1.      For mechanical (tactile, pressure, and vibration) thresholds, there was no significant difference between conditions for detection and pain. Both tactile and pressure thresholds were lower on the affected side than the control side, while vibration threshold was the same on both sides.2.      For thermal (hot and cold) thresholds, there was no significant difference between conditions for detection. However, the heat pain threshold was slightly but significantly different between sides during SES activation (p=0.01).

3.      For wind-up-like pain, there was no significant difference between conditions for detection and tolerance.

4.      Areas of brush allodynia were significantly smaller (p=0.037) during the activated condition (225cm2) than the deactivated condition (310cm2).

5.      There were no significant differences between conditions for areas of spontaneous pain or pinprick hyperalgesia.

6.      There was no significant difference between conditions for present or recent pain intensity.

7.      Overall, 93% of patients were able to identify SES activation.
Cioni et al. 1995

Italy

Case Series

N=25

 Population: Age=33-76 yr; Gender: males=19, females=6; Time since injury=1-39 yr. Type of pain=neuropathic and musculoskeletal.

Treatment: An epidural electrode was inserted percutaneously over the posterior columns of the spinal cord. Spinal cord stimulation was performed with the following parameters: 85 cycles/sec, duration of 210 msec and varied intensity for comfortable parasthesias 30 min every 3 hr during the day. Mean follow-up was 37.3 mo.

Outcome Measures: Pain relief.

 1.     During stimulation, 22 patients reported paresthesia overlapping the painful area.2.     9 patients enjoyed 50% pain relief at the end of the test period. No pain relief was found in 3 of the patients. No statistical results reported.

Discussion

Meier et al. (2015) evaluated the effectiveness of activated SCS and deactivated SCS. The study found activated SCS resulted in smaller areas of brush allodynia compared to deactivated. No difference was seen in wind-up like pain. Cioni et al. (1995) reported inserting epidural electrodes over the posterior columns of the spinal cord to allow for spinal cord stimulation. During spinal cord stimulation, 22 patients reported paraesthesia overlapping the painful area. Nine patients reported 50% pain relief and three patients experienced no pain relief.

Conclusion

There is level 1b evidence (Meier et al. 2015) that spinal cord stimulation map improve allodynia related pain post SCI.

There is level 4 evidence (from one case series study: Ciono et al. 1995) that spinal cord stimulation improves post-SCI pain.

Spinal cord stimulation may improve post-SCI allodynia pain.

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