Spinal cord stimulation relieves chemotherapy-induced pain: a clinical case report.
ABSTRACT We present two patients with chemotherapy-induced painful neuropathy that had been poorly controlled with medications but successfully treated with spinal cord stimulation (SCS). A trial period of SCS provided effective pain relief in both patients who subsequently underwent permanent stimulator implantation. Psychophysical tests were performed before and after the implantation of trial and permanent stimulators. SCS improved pain scores and facilitated a reduction of medications. Both patients reported improved gait and one of them also reported an increase in leg flexibility. Psychophysical tests demonstrated an improvement in touch and sharpness detection thresholds. In summary, SCS offers a therapeutic option for patients with chemotherapy-induced peripheral neuropathy who have poor pain relief with standard medical treatment.
Full-textDOI: · Available from: Juan Cata, May 28, 2015
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ABSTRACT: Background: Although the long-term outcomes for spinal cord stimulation (SCS) have been reported, long-term outcomes of patients who underwent revisions of the SCS with paddle leads are lacking. Objective: To report the long-term outcomes of 39 patients that had percutaneous SCS revised with a new paddle lead. Methods: Baseline and follow-up mail-in questionnaires assessed pain and disability levels with numerical rating scales (NRS-11), somatotopical overlap between SCS-related paresthesias and areas of chronic pain, and overall satisfaction. Analysis was performed with regard to age, gender, diagnosis, duration of disease, number of surgical revisions, complications, and interval between surgeries. Results: After surgical revision, 20 patients (50%) had at least 3 point reduction in the numerical rating scale. Greater pain reduction was correlated with better coverage (P = .001). Coverage area was greater in patients with a single revision than patients with multiple revisions (P = .01). Good satisfaction was reported by 25 patients (62.5%) who indicated that they would undergo the procedure again in order to achieve the same results. These patients had significantly greater pain reduction (P = .001) and better coverage (P = .002) than patients who reported otherwise. No other major complication occurred. Conclusion: Revision of percutaneous SCS systems with implantation of a new paddle lead is safe and more effective in patients who have undergone not more than one prior revision.Neurosurgery 06/2014; DOI:10.1227/NEU.0000000000000460 · 3.03 Impact Factor
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ABSTRACT: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several chemotherapeutics used in the treatment of all the most common malignancies. There are several defined mechanisms of nerve damage that take place along different areas of the peripheral and the central nervous system. Treatment is based on symptom management and there are several classes of medications found to be efficacious in the treatment of neuropathic pain. Neuropathic pain that persists despite appropriate pharmacotherapy may respond to interventional procedures that span a range of invasiveness. The purpose of this review article is to examine the basic science of neuropathy and currently available treatment options in the context of chemotherapy induced peripheral neuropathy.Gynecologic Oncology 01/2015; 136(3). DOI:10.1016/j.ygyno.2015.01.524 · 3.69 Impact Factor
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ABSTRACT: Purpose The goal in this study was to determine the incidence of subclinical neuropathy in treatment-naive patients with multiple myeloma (MM) with no history of peripheral neuropathy using quantitative sensory tests (QSTs) and its correlation with innervation density of the extremities using noninvasive laser reflectance confocal microscopy. Patients and Methods QST results were collected for 27 patients with a diagnosis of MM and compared with data collected from 30 age- and sex-matched healthy volunteers. Skin temperature, sensorimotor function (grooved pegboard test), and detection thresholds for temperature, sharpness, and low-threshold mechanical stimuli (von Frey monofilaments and bumps detection test) were measured. Meissner's corpuscle (MC) density in the fingertips was assessed using in vivo laser reflectance confocal microscopy. Results Patients showed a high incidence (> 80%) of >= one subclinical QST deficit. These included increased von Frey, bumps, and warmth detection thresholds as compared with healthy volunteers. Patients also showed increases in cold pain, sensorimotor deficits (grooved pegboard test), and higher overall neuropathy scores. MC density was significantly lower in patients than controls and showed significant inverse correlation with bumps detection threshold. Conclusion Patients with MM commonly present with sensory and sensorimotor deficits before undergoing treatment, and these deficits seem to result from disease-related decreases in peripheral innervation density. (C) 2014 by American Society of Clinical OncologyJournal of Clinical Oncology 08/2014; 32(28). DOI:10.1200/JCO.2013.54.5418 · 17.88 Impact Factor