Treatment of Neuropathic Cancer Related Pain with Spinal Cord Stimulation

Treatment of Neuropathic Cancer Related Pain with Spinal Cord Stimulation

Yuri Merkulov, MD, Alexander E. Yakovlev, MD, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wisconsin, USA

INTRODUCTION
Up to 40% of chronic cancer pain has a neuropathic component. This type of pain often responds poorly to opioids. For these patients interventional management approaches have received considerable attention. Spinal cord stimulation (SCS) has been used with increased frequency for the treatment of intractable cancer pain.

METHODS
Between April 2006 and September 2008, 18 patients with neuropathic cancer related back pain underwent SCS placement. These patients underwent surgical interventions and radiation therapy. The patients had no evidence of local recurrences or metastases. Patients failed conservative therapy and had no pain relief after epidural steroid blocks. They underwent successful trial of percutaneous placement of two 8-electrode epidural leads positioned at T8-T9-T10-T11 level. During the 2 day SCS trial, the patients reported >50% improvement in pain. Two weeks later the patients underwent implantation with permanent leads and RestorePRIME (Medtronic Inc.) non-rechargeable or RestoreULTRA rechargeable generators.

RESULTS
At 12 months post-implant, all patients reported significant pain relief (VAS scores 1-4 out of 10) and improved functional status. They were able to decrease or discontinue use of pain medications.

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CONCLUSION
SCS may be a therapeutic alternative for patients with cancer related low back pain who in the past exhausted all available treatments. Patients with co-morbidities make them less ideal candidates for more invasive interventions. The therapy is reversible should patients lose its pain-alleviating effect or if their pain resolves.