Spinal Cord Stimulation as a Treatment Option for Intractable Neuropathic Cancer Pain

Abstract

Nearly 6,750,000 people suffer moderate to severe cancer-related pain each year. Unfortunately, 10% to 15% of these patients fail to achieve acceptable pain relief with conventional management. Spinal cord stimulation (SCS) has been used with increased frequency for successful treatment of intractable cancer pain. We present two cases of intractable, refractoryto-conventional treatment cancer pain that were successfully treated with SCS. Case 1 reports a 51-year-old male with burning pain at the left groin site of inguinal metastases, post-surgical and intraoperative radiation therapy for treatment of squamous cell carcinoma of the anus. Case 2 reports a 43-year-old woman with intractable, burning, throbbing, and shooting pain, post-debulking followed by radiation of a metastatic colon carcinoma. In both cases SCS implantation provided 90% to 100% pain relief, improved functioning and sleep, and discontinuation of pain medications, sustained through 12 months. Case Presentations Case 1The patient is a 51-year-old male who underwent anterior-posterior resection and intraoperative radiation therapy for squamous cell carcinoma of the anus. He later developed inguinal adenopathy, which was also irradiated because it contained secondary metastasis from the carcinoma of the anus. Approximately 4 months post-irradiation, he developed burning pain in the left groin at the site of the inguinal metastasis. The pain was described as hot and burning, occasionally sharp and shooting, with visual analog scale (VAS) scores at rest of 2 to 4 out of 10 in severity. The patient was most aggravated by the fact that, during activity, the pain escalated to a VAS score of 8 out of 10 and significantly limited his activities. Occasionally, sitting or getting off his feet would afford him some comfort; however, the pain never disappeared entirely.The patient had used ibuprofen, acetaminophen, gabapentin, cyclobenzaprine, amitriptyline, and topical ointments, but they did not provide any relief. Because codeine, oxycodone, and hydrocodone had caused a rash in the past, the use of opioids was limited. Darvocet, fentanyl patches, and ilioinguinal and iliohypogastric nerve blocks provided the patient with minimal pain relief. He was counseled on alternative options of treatment, including an intrathecal drug delivery system and spinal cord stimulation (SCS). He chose SCS.Once the decision has been made to proceed to SCS, a successful trial of percutaneous placement of temporary epidural leads must be performed before implantation of the entire SCS system. These temporary leads are connected to an external pulse generator, and patients typically wear them for a few days while

Dorsal Root Ganglion Stimulation Used for the Treatment of Chronic Neuropathic Pain in the Groin: A Single-Center Study With Long-Term Prospective Results in 34 Cases

“…SCS stimulation has also been used in the mid thoracic area and could achieve pain relief, even for groin pain. There was an improvement of more than 80% . The effects of DRGS used for pain in the leg and groin were examined in an important study which also showed good results .…”

Treatment of Urinary Voiding Dysfunction Syndromes With Spinal Cord Stimulation

“…7 Spinal cord stimulation has been used to successfully treat chronic pain in patients with failed back syndrome, 8,9 ischemic limb pain, 10 angina pectoris, 11 painful peripheral neuropathies, 12,13 and cancer related pain. 14,15 Spinal cord stimulation may be a therapeutic alternative for patients with combined urinary dysfunction symptoms and radicular low back pain who, in the past, exhausted all available treatments or failed test stimulation before the placement of the device for InterStim therapy. Spinal cord stimulation and InterStim therapy are considered to be minimally invasive surgical interventions that have successfully positioned themselves between more conservative medical treatments and more invasive surgical procedures which may have mixed results.…”

Management of Postherniorrhaphy Chronic Neuropathic Groin Pain: A Role for Dorsal Root Ganglion Stimulation

“…A number of reports applying spinal cord stimulation (SCS) at the T7‐T9 levels have indicated some applicability to chronic neuropathic groin pain, in some cases relieving 75% or more . However, a limitation of SCS with groin pain as with all axial pain distributions is that it is extremely difficult to achieve selective coverage of the painful regions; patients may find it necessary to tolerate “a pair of pants” of extraneous paresthesia in order to also capture the relatively discrete painful region.…”

“…57 A number of reports applying spinal cord stimulation (SCS) at the T7-T9 levels have indicated some applicability to chronic neuropathic groin pain, in some cases relieving 75% or more. [58][59][60] However, a limitation of SCS with groin pain as with all axial pain distributions is that it is extremely difficult to achieve selective coverage of the painful regions 61,62 ; patients may find it necessary to tolerate "a pair of pants" of extraneous paresthesia in order to also capture the relatively discrete painful region. It has been proposed that dorsal root ganglia (DRG) stimulation may be a pain management option 63 that is a viable alternative to SCS for this pain distribution, because the recruitment of distally projecting sensory neurons may be more precisely selected to achieve a limited region of paresthesia.…”