Spinal Cord Stimulation (SCS) for Chronic Abdominal Pain

Spinal Cord Stimulation (SCS) for Chronic Abdominal Pain

Author Block: Alexander E. Yakovlev, Comprehensive Pain Management of The Fox Valley, SC, Appleton, WI; Beth E. Resch, APNP, Comprehensive Pain Management of The Fox Valley, SC, Appleton, WI;

Abstract:
Introduction
Abdominal pain is the leading gastrointestinal complaint for outpatient visits and is also the most frequently cited chief complaint in emergency departments. The etiology of this pain is complex but it is hypothesized that visceral hypersensitivity is a factor. Use of SCS has been documented to benefit patients with chronic abdominal pain. The first case report of SCS for treatment of visceral pain was in a patient with irritable bowel syndrome. Subsequently, reports described use of SCS for treating pain related to chronic pancreatitis, generalized abdominal pain, abdominal wall neuromas, and post-traumatic splenectomy.

Methods
Between February 2007 and May 2008, 8 patients suffering from chronic abdominal pain underwent SCS placement. All of them were females aged from 18 to 63. The patients failed conservative therapy and had short lasting pain relief after celiac plexus blocks. They underwent successful trial of percutaneous placement of two 8-electrode epidural leads positioned at T6-T7. During the SCS trial the patients reported > 50% improvement in pain. Two weeks later the patients underwent implantation with permanent leads and RestorePRIME non-rechargeable or RestoreULTRA (Medtronic Inc., Minneapolis, MN) rechargeable generators.

Results
All patients reported significant pain relief (>80% reduction in VAS) with SCS. They were able to decrease or discontinue use of pain medications and reported other positive outcomes including the ability to return to social and educational activities and improved family relationships.

Conclusions
SCS may be a therapeutic alternative for patients with chronic abdominal pain who in the past exhausted all available treatments. SCS is also an excellent option for patients with co-morbidities which make them less ideal candidates for more invasive interventions. This technique is a relatively easy to perform, effective, and safe procedure. The therapy is reversible should patients lose its pain-alleviating effect or if abdominal pain resolves.