Article

Spinal cord stimulation relieves chemotherapy-induced pain: a clinical case report

Department of Symptom Research, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Journal of Pain and Symptom Management (Impact Factor: 2.8). 02/2004; 27(1):72-8. DOI: 10.1016/j.jpainsymman.2003.05.007
Source: PubMed

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.

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    • "Dellon et al (2004) reported surgical decompression as beneficial for CIPN in a small case series. Cata et al (2004) similarly reported a beneficial effect in two patients with CIPN treated with spinal cord stimulation. This technique is used for a variety of chronic pain problems and capitalizes on the gate theory of pain where activity of large fibres generated by the stimulator will inhibit concurrent activity (pain) coming from smaller fibres. "
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    ABSTRACT: Chemotherapy-induced peripheral neuropathy (CIPN) is still a common and disabling side effect of many chemotherapy agents in use today. Unfortunately, neither prophylactic strategies nor symptomatic treatments have proven useful yet. This review will discuss the diagnosis and evaluation of neuropathy in cancer patients, as well as reviewing the various prophylactic and symptomatic treatments that have been proposed or tried. However, sufficient evidence is lacking to recommend any of these treatments to patients suffering with CIPN. Therefore, the best approach is to treat symptomatically, and to start with broad-spectrum analgesic medications such as non-steroidal anti-inflammatory drugs (NSAIDs). If NSAIDs fail, a reasonable second-line agent in properly selected patients may be an opioid. Unfortunately, even when effective in other types of neuropathic pain, anti-depressants and anticonvulsants have not yet proven effective for treating the symptoms of CIPN.
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    ABSTRACT: The term pain management applies mainly to chronic pain rather than acute pain. In its broadest sense it includes a range of physical (e.g. spinal cord stimulation) and pharmacological (e.g. opioid drugs, intrathecal pumps, facet joint injections) as well as psychological interventions. Although the purpose of physical interventions is to reduce the intensity, frequency and duration with which pain is experienced, the overall aim of pain management is to ameliorate the experience of pain in its broadest sense rather than to eradicate it. Acute pain, such as postoperative pain, is expected to have a self-limiting time course and treatments are primarily directed at preventing its occurrence or reducing the magnitude of experienced pain during this period of time. This approach has been transferred to many medical treatments of chronic pain (such as those listed above) but while the elimination of pain is a worthy goal for chronic pain sufferers it is generally not possible with our present understanding of the neurobiology of chronic pain. By definition chronic pain is longstanding, usually defined as greater than six months but often many years. Most sufferers will have received a wide range of pharmacological treatments without experiencing complete relief. When pain persists over a period of time its impact becomes widespread, it needs to be considered as a multifaceted construct and its treatment is necessarily more complex. This chapter is therefore concerned primarily with psychological approaches to this problem.
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