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414 SPINAL CORD STIMULATION FOR TREATMENT OF INTRACTABLE PAIN FROM FAILED BACK SURGERY SYNDROME: A SUCCESSFUL EXPERIENCE AT SINGAPORE GENERAL HOSPITAL
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Posters / European Journal of Pain Supplements 4 (2010) 47–146
lidocaine-containing patches and capsaicin cream offer moderate pain relief to some patients with PHN, but they may be associated with adverse events that limit their use. Objectives: In this retrospective study, we assessed the effectiveness of selective spinal nerve root blocks with local anesthetics and steroids for the treatment of PHN patients. Methods: We treated six PHN patients. After CT scanning, we selected target spinal nerve corresponding to dermatome of PHZ patients using nerve stimulator. We injected local anesthetics and steroids to the selected spinal nerve roots under CT-guided. Results: Among six patients, two were improved about 60% and the others were improved more than 90%. Conclusions: Selective spinal nerve root block with nerve stimulator may be one of the very effective treatment for PHN patients. 414 SPINAL CORD STIMULATION FOR TREATMENT OF INTRACTABLE PAIN FROM FAILED BACK SURGERY SYNDROME: A SUCCESSFUL EXPERIENCE AT SINGAPORE GENERAL HOSPITAL K. Pasutharnchat1 , K.Y. Ho2 . 1 Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2 Pain Management Centre, Singapore General Hospital, Singapore, Singapore Introduction: Treatment of failed back surgery syndrome (FBSS) is challenging as conservative therapies and repeated surgery often fail to provide an adequate pain relief. Spinal cord stimulation (SCS) is an effective therapeutic option in such patients. In Southeast Asia, while the number of FBSS with failure to conservative treatments and interventional pain procedures has been increasing, SCS is still not widely performed due to the high costs, lacking of resources and experienced pain specialists. Objectives: To describe the first successful case of treating intractable neuropathic pain from FBSS in a patient at a public sector’s hospital in Singapore. Methods: Setting: Pain management center at Singapore general hospital. Case summary: A 23-year-old man presented with severely disabling low back pain and radicular pain after a spinal surgery for 2 years, ultimately causing dependence to wheelchair. Medical treatment, rehabilitation and several interventional pain procedures failed to relieve his pain. In 2008, we performed a permanent implantation of epidural leads for SCS after a successful trial of SCS. Results: The patient reported dramatic recovery of pain without complications. Three months after the procedure, with intensive physiotherapy and rehabilitation, his medication intake was reduced. He could walk and return to work functionally. Conclusions: We reported the first successful case of treating intractable pain from FBSS with SCS in a setting of a public sector’s hospital in Singapore. Comprehensive pain program, training of pain interventionists and special interventions, such as SCS, should also be supported and developed in other Southeast Asian countries. 415 EPIDUROSCOPY FOR THE TREATMENT OF FAILED BACK SURGERY SYNDROME: PRELIMINARY RESULTS OF A PROSPECTIVE STUDY D. Peek1 , P. Vanelderen2,3 , P. De Vooght1 , M. Puylaert1 , R. Mestrum1 , R. Heylen1 , J. Van Zundert1 . 1 Department of Anesthesiology, Critical Care Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium; 2 Department of Anesthesiology, Pain Therapy and Palliative Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 3 Department of Anesthesiology, Critical Care Medicine and Multidisciplinary Pain Center Ziekenhuis Oost-Limburg, Genk, Belgium Introduction: Epiduroscopy is a diagnostic and therapeutic technique used in patients with Failed Back Surgery Syndrome (FBSS). Epidural fibrosis is implicated as a possible cause of persistent pain. Often these patients require a dorsal column stimulator (DCS) to manage their pain.
Objectives: Evaluate if epiduroscopy reduces the need for DCS implantation in FBSS. Methods: Patients with FBSS with predominant leg pain and epidural fibrosis on MRI were included. Under light sedation (remifentanil, propofol) a video-guided catheter (Myelotec® , Promed Ltd, Somersham, Great Britain) was introduced through the sacral hiatus into the epidural space. Subsequently mechanical adhesiolysis of fibrosis around the culprit nerve root was performed. 120 mg methylprednisolone, 1500 U hyalyronidase, 75 mg clonidine and 5 mg ropivacaine were administered epidurally to prevent recurrence of fibrosis. Pain and medication intake were measured with the Visual Analogue Scale (VAS) and Medication Quantification Scale (MQS) respectively. A paired t-test (a-leveling: 0.05) and a non-parametric Wilcoxon matched pairs test was used for the statistical analysis of the VAS and MQS respectively (Statplus for Mac® , Analystsoft, Vancouver, Canada). Results: Five patients were included. All had epidural infiltrations and pulsed radiofrequency treatment without improvement. The baseline VAS was 8.2 and declined to 4.5 (P = 0.015) and 5 (P = 0.03) 3 and 6 months after epiduroscopy respectively. The baseline MQS was 15.5 and declined to 13.6 and 11.9 after 3 and 6 months respectively (not significant). One patient required a DCS to control his pain. Conclusion: Epiduroscopy can be of value for the treatment of FBSS before implantation of a DCS. 416 PULSED RADIOFREQUENCY THERAPY ON THE SUPRASCAPULAR NERVE REDUCES CHRONIC SHOULDER PAIN M. Pieran. Teaching Hospital Olomouc, Olomouc, Czech Republic Introduction: Many shoulder disorders are accompanied by an acute or chronic pain, which often results in restriction in glenohumeral joint range of motion. Sequential block of the suprascapular nerve improves the spasm, modulates both afferent input and motor control and thus, offers an excellent possibility to influence post-traumatic and functional tissue changes not responding to conservative rehabilitation. Objectives: The aim of the study was to evaluate an efficacy of pulsed radiofrequency therapy (PRFT) on suprascapular nerve in chronic shoulder pain resistant to conservative treatment in 21 patients. Methods: Twenty-one selected patients with chronic shoulder pain underwent PRFT on suprascapular nerve under fluoroscopic navigation. The success rate of the procedure was evaluated recording Visual Analogue Scale (VAS) and shoulder range of motion before, two hours and three months after PRFT. Results: Pain reduction to VAS 0–2 immediately after PRFT was observed in 19 patients (90%). After three months 50% pain reduction was reported by 16 patients (76%). Significant improvement in shoulder range of motion was observed in 14 patients (67%). Substantial reduction in analgesic pharmacotherapy were recorded in twelve patients (57%). Complications occured in one patient and they were considered as minor. Conclusions: PRFT therapy on suprascapular nerve seems to be effective and safe treatment of chronic shoulder pain resistant to conservative treatment in the group of 21 patients. 417 SPINAL CORD STIMULATION FOR THE TREATMENT OF NEUROPATHIC SYNDROMES UTILIZING PERCUTANEOUS AND SURGICAL LEADS P. Zenetos1 , R. Raggi2 . 1 Pain Management, 2 Wyckoff Heights Medical Center, Brooklyn, NY, USA Introduction: Significant debate exists as to which SCS modality is preferable in treating neuropathic back pain. In this study we
Posters / European Journal of Pain Supplements 4 (2010) 47–146
lidocaine-containing patches and capsaicin cream offer moderate pain relief to some patients with PHN, but they may be associated with adverse events that limit their use. Objectives: In this retrospective study, we assessed the effectiveness of selective spinal nerve root blocks with local anesthetics and steroids for the treatment of PHN patients. Methods: We treated six PHN patients. After CT scanning, we selected target spinal nerve corresponding to dermatome of PHZ patients using nerve stimulator. We injected local anesthetics and steroids to the selected spinal nerve roots under CT-guided. Results: Among six patients, two were improved about 60% and the others were improved more than 90%. Conclusions: Selective spinal nerve root block with nerve stimulator may be one of the very effective treatment for PHN patients. 414 SPINAL CORD STIMULATION FOR TREATMENT OF INTRACTABLE PAIN FROM FAILED BACK SURGERY SYNDROME: A SUCCESSFUL EXPERIENCE AT SINGAPORE GENERAL HOSPITAL K. Pasutharnchat1 , K.Y. Ho2 . 1 Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2 Pain Management Centre, Singapore General Hospital, Singapore, Singapore Introduction: Treatment of failed back surgery syndrome (FBSS) is challenging as conservative therapies and repeated surgery often fail to provide an adequate pain relief. Spinal cord stimulation (SCS) is an effective therapeutic option in such patients. In Southeast Asia, while the number of FBSS with failure to conservative treatments and interventional pain procedures has been increasing, SCS is still not widely performed due to the high costs, lacking of resources and experienced pain specialists. Objectives: To describe the first successful case of treating intractable neuropathic pain from FBSS in a patient at a public sector’s hospital in Singapore. Methods: Setting: Pain management center at Singapore general hospital. Case summary: A 23-year-old man presented with severely disabling low back pain and radicular pain after a spinal surgery for 2 years, ultimately causing dependence to wheelchair. Medical treatment, rehabilitation and several interventional pain procedures failed to relieve his pain. In 2008, we performed a permanent implantation of epidural leads for SCS after a successful trial of SCS. Results: The patient reported dramatic recovery of pain without complications. Three months after the procedure, with intensive physiotherapy and rehabilitation, his medication intake was reduced. He could walk and return to work functionally. Conclusions: We reported the first successful case of treating intractable pain from FBSS with SCS in a setting of a public sector’s hospital in Singapore. Comprehensive pain program, training of pain interventionists and special interventions, such as SCS, should also be supported and developed in other Southeast Asian countries. 415 EPIDUROSCOPY FOR THE TREATMENT OF FAILED BACK SURGERY SYNDROME: PRELIMINARY RESULTS OF A PROSPECTIVE STUDY D. Peek1 , P. Vanelderen2,3 , P. De Vooght1 , M. Puylaert1 , R. Mestrum1 , R. Heylen1 , J. Van Zundert1 . 1 Department of Anesthesiology, Critical Care Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium; 2 Department of Anesthesiology, Pain Therapy and Palliative Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; 3 Department of Anesthesiology, Critical Care Medicine and Multidisciplinary Pain Center Ziekenhuis Oost-Limburg, Genk, Belgium Introduction: Epiduroscopy is a diagnostic and therapeutic technique used in patients with Failed Back Surgery Syndrome (FBSS). Epidural fibrosis is implicated as a possible cause of persistent pain. Often these patients require a dorsal column stimulator (DCS) to manage their pain.
Objectives: Evaluate if epiduroscopy reduces the need for DCS implantation in FBSS. Methods: Patients with FBSS with predominant leg pain and epidural fibrosis on MRI were included. Under light sedation (remifentanil, propofol) a video-guided catheter (Myelotec® , Promed Ltd, Somersham, Great Britain) was introduced through the sacral hiatus into the epidural space. Subsequently mechanical adhesiolysis of fibrosis around the culprit nerve root was performed. 120 mg methylprednisolone, 1500 U hyalyronidase, 75 mg clonidine and 5 mg ropivacaine were administered epidurally to prevent recurrence of fibrosis. Pain and medication intake were measured with the Visual Analogue Scale (VAS) and Medication Quantification Scale (MQS) respectively. A paired t-test (a-leveling: 0.05) and a non-parametric Wilcoxon matched pairs test was used for the statistical analysis of the VAS and MQS respectively (Statplus for Mac® , Analystsoft, Vancouver, Canada). Results: Five patients were included. All had epidural infiltrations and pulsed radiofrequency treatment without improvement. The baseline VAS was 8.2 and declined to 4.5 (P = 0.015) and 5 (P = 0.03) 3 and 6 months after epiduroscopy respectively. The baseline MQS was 15.5 and declined to 13.6 and 11.9 after 3 and 6 months respectively (not significant). One patient required a DCS to control his pain. Conclusion: Epiduroscopy can be of value for the treatment of FBSS before implantation of a DCS. 416 PULSED RADIOFREQUENCY THERAPY ON THE SUPRASCAPULAR NERVE REDUCES CHRONIC SHOULDER PAIN M. Pieran. Teaching Hospital Olomouc, Olomouc, Czech Republic Introduction: Many shoulder disorders are accompanied by an acute or chronic pain, which often results in restriction in glenohumeral joint range of motion. Sequential block of the suprascapular nerve improves the spasm, modulates both afferent input and motor control and thus, offers an excellent possibility to influence post-traumatic and functional tissue changes not responding to conservative rehabilitation. Objectives: The aim of the study was to evaluate an efficacy of pulsed radiofrequency therapy (PRFT) on suprascapular nerve in chronic shoulder pain resistant to conservative treatment in 21 patients. Methods: Twenty-one selected patients with chronic shoulder pain underwent PRFT on suprascapular nerve under fluoroscopic navigation. The success rate of the procedure was evaluated recording Visual Analogue Scale (VAS) and shoulder range of motion before, two hours and three months after PRFT. Results: Pain reduction to VAS 0–2 immediately after PRFT was observed in 19 patients (90%). After three months 50% pain reduction was reported by 16 patients (76%). Significant improvement in shoulder range of motion was observed in 14 patients (67%). Substantial reduction in analgesic pharmacotherapy were recorded in twelve patients (57%). Complications occured in one patient and they were considered as minor. Conclusions: PRFT therapy on suprascapular nerve seems to be effective and safe treatment of chronic shoulder pain resistant to conservative treatment in the group of 21 patients. 417 SPINAL CORD STIMULATION FOR THE TREATMENT OF NEUROPATHIC SYNDROMES UTILIZING PERCUTANEOUS AND SURGICAL LEADS P. Zenetos1 , R. Raggi2 . 1 Pain Management, 2 Wyckoff Heights Medical Center, Brooklyn, NY, USA Introduction: Significant debate exists as to which SCS modality is preferable in treating neuropathic back pain. In this study we