Poster 333 Utility of Spinal Cord Stimulator to Modulate Lower Limb Spasticity and Pain in a Patient With Spinal Cord Injury: A Case Report

Abstract

Work and Physical Activity (FABQ-W and FABQ-P respectively) and the Mindfulness survey, both of which were administered before lumbar TFESI. Design: Prospective cohort study. Setting: Urban, academic physiatry practice. Participants: A total of 25 patients who received lumbar transforaminal epidural spinal injections (TFESI) for back pain. Interventions: Not applicable. Main Outcome Measures: In this study, success was defined by a reduction in pain score more than 30% at weeks 1, 2, 3, and 4. Results: Back pain was successfully treated in 13 of 25 patients at week 1 after TFESI, 11 of 25 at week 2, 12 of 24 at week 3, and 10 of 24 at week 4. Subjects with successful lumbar TFESI scored higher on preinjection FABQ-W, lower on FABQ-P, and lower on the mindfulness questionnaire. Those subjects who experienced a successful outcome at week 2 scored significantly lower on preinjection FABQ-W (21.6 versus 30.6; Pϭ. 03).Conclusions: There appears to be an association of fear avoidance behaviors and successful outcome of lumbar TFESI. The preinjection FABQ-W had the greatest association with successful outcome at week 2. Further work is needed to evaluate fear avoidance and mindfulness as prediction tools to identify patients who would benefit the most from interventions for pain.

Current Evidence Lacking to Guide Clinical Practice for Spinal Cord Stimulation in the Treatment of Neuropathic Pain in Spinal Cord Injury: A Review of the Literature and a Proposal for Future Study

“…Twenty‐two reports were identified that included at least 1 patient with neuropathic pain from SCI treated with SCS. Five were published case reports, 1 was a prospective nonrandomized, noncontrolled study, and the remaining 16 were case series or reports published as conference abstracts . All reports other than that of Kishima et al were retrospective in nature.…”

“…In addition to pain outcome measures (see Table ), many of the reports mentioned other positive benefits of SCS in their patients. Three reports commented that their patients had an improvement in their spasticity post‐SCS based on the Modified Ashworth Scale, while 8 reports mentioned change in pain medication usage. All but 1 article reported a decrease in pain medication use.…”

“…Five were published case reports, 20,27-30 1 was a prospective nonrandomized, noncontrolled study, 31 and the remaining 16 were case series or reports published as conference abstracts. [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] All reports other than that of Kishima et al 31 were retrospective in nature. Table 1 shows detailed descriptions of the included reports.…”