Combined Use of Intrathecal Therapy and Spinal Cord Stimulation for Neuropathic Lower Extremity and Abdominal Pain
Alexander Yakovlev, MD; Angela Parmentier, APNP; Jammi Cairns, APNP • Comprehensive Pain Management of the Fox Valley, SC
820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
INTRODUCTION
Irritable bowel syndrome (IBS) is a disorder that leads to debilitating symptoms, including abdominal pain and cramping and changes in bowel movements affecting approximately 1 in 6 people. As causes for this condition continue to evolve, studies have linked visceral hypersensitivity and spinal nociceptor hyperexcitability between the gastrointestinal system and nervous system. Described here is a reported case of improved abdominal pain and cramping with Spinal Cord Stimulation (SCS) in addition to regularity in bowel habits.
METHODS
This 62-year-old man presents with a long history of chronic abdominal pain as a result of chronic alcoholic pancreatitis and alcoholic peripheral neuropathy for which he is taking both long-acting and short-acting medications. The decision was made to proceed with an IPP trial. After greater than 85% pain relief with intrathecal morphine, patient underwent implantation. He was able to discontinue the use of oral opioids and rely solely on the ITP for pain control for three years. Unfortunately, pain in both feet started to come back, despite escalating titration of intrathecal morphine and additional bupivacaine. Decision was made to proceed with SCS trial for bilateral neuropathic lower extremity pain. During the trial two 8-electrode leads were inserted through the Tuohy needles and were positioned at the level of T12-L1. Patient reported resolution in the pain in his legs. Intrathecal setting remained at morphine 5.907 mg/day and bupivacaine at 4.7262 mg/day.
RESULTS
The patient reports sustained pain relief in his abdomen and bilateral lower extremities with the use of intrathecal therapy and SCS. Patient is no longer receiving any oral opioid analgesics.
CONCLUSIONS
SCS should be considered in patients with intrathecal delivery systems to cover pain unmanaged by opioid analgesics. Neuromodulation can be an effective adjunct therapy to an intrathecal system.
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