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473: Subcutaneous Targeted Stimulation in Chronic Pain Conditions - a 6 Year Retrospective Study
200
Posters
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Chronic Pain Management
473. Subcutaneous targeted stimulation in chronic pain conditions - A 6 year retrospective study Goroszeniuk1,
Reddy1,
Kothari2,
Khan2,
T. R. S. R. N. Pratap2, K. Sanderson2 1Guys and St Thomas’ NHS Foundation Trust, Pain Management, London, UK, 2Guys and St Thomas’ NHS Foundation Trust, London, UK Introduction: Subcutaneous targeted stimulation (TS) involves placing a neurostimulating implant subcutaneously at the epicentre of the painful area (target) rather than stimulating the peripheral nerves supplying it. It was first reported in 2003 and the first permanent implant case series followed in 20061. It is effective in treating chronic painful conditions of non-dermatomal distribution resulting in reduction of pain for varying duration. We are presenting an evaluation of our experience with permanent TS in the treatment of various chronic pain conditions. Methods: This iThis is a retrospective review of twenty one (21) patients with the permanent TS. Outcome measures analysed were pain and medication reduction, complications and stimulation parameters.Each implantation was preceded by external neuromodulation, temporary stimulating trial and pre-implantation pain management programme in that sequence as per the strict criteria of our Guy’s & St.Thomas’ Hospital Algorithm. Pain reduction of 50% and over during the trial qualified the patient for permanent implant. The permanent leads were implanted subcutaneously at the epicentre of pain for largest possible coverage. ANS and Medtronic systems were used. Results: 18 patients showed greater than 50% reduction in pain and significant reduction in analgesic use; 1 unit was removed due to infection; leads repositioned in 3; IPG repositioned in1. Majority showed significant reduction in analgesic use. Conclusions: TS is a new, promising technique. The approach to insert the stimulating lead(s) directly at the centre of pain subcutaneously is simple and effective. TS can be utilised as a sole procedure or in combination with peripheral or central stimulation. The outcome of this review supports our initial report.
Reference 1. Goroszeniuk T, Kothari S, Hamann W. Subcutaneous Neuromodulating Implant targeted at the site of pain; Reg Anaesth Pain Med 2006:31(2): 168-171.
477. Reflex sympathy dystrophy syndrome treatment and outcome J. Cruz, M. Barbosa, P. Pinto, I. Fonseca, M. Gouveia, J. Correia Chronic Pain Unit, Anesthesiology, Porto, Portugal Aim of Investigation: To evaluate the efficacy of conservative and invasive treatment in reflex sympathy dystrophy syndrome (RSDS) and define the epidemiological and clinical caracteristics of patients. Methods: Data analysis of the Chronic Pain Unit (CPU) patients suffering from RSDS, followed in our hospital between January 1997 and December 2007, were retrospectively reviewed. A telephone interview was conducted to evaluate the actual status of the patients. Non-parametric tests and Chi square were used to analyze data. Results: During this period 37 patients were followed (78%female). The mean age was 51 years (range 16-80). The incidence of RSDS was 1‰. RSDS Type I was 86%. 70% of RSDS were related to the upper limb. No statistically significant differences were found for patients with RSDS according to socio-demographic factors. All patients were under pharmacological treatment and 22 (60%) had multiple drug therapy. 11 patients were submitted to stellate ganglion block Fifteen patients (41%) were submitted to spinal cord stimulation, one (3%) patient with RSDS in the lower limb underwent intrathecal baclofen pump; all had total remission of pain and were asymptomatic. Neuromodulation therapy positively influenced pain and symptom control and reduced pharmacological treatment (p⬍ 0.05). Conclusions: Spinal cord stimulation seems to be the most efficient choice for RSDS treatment (pain and related signs and symptoms). Most likely, the total improvement of symptoms of RSDR in the one patient with baclofen might be due to the associated tonic dystonia, an uncommoncomplication of RSDS. The diversity of different treatments and their efficacy is dependent on an accurate and early diagnosis of pain, signs symptoms associated with RSDS.
Posters
•
Chronic Pain Management
473. Subcutaneous targeted stimulation in chronic pain conditions - A 6 year retrospective study Goroszeniuk1,
Reddy1,
Kothari2,
Khan2,
T. R. S. R. N. Pratap2, K. Sanderson2 1Guys and St Thomas’ NHS Foundation Trust, Pain Management, London, UK, 2Guys and St Thomas’ NHS Foundation Trust, London, UK Introduction: Subcutaneous targeted stimulation (TS) involves placing a neurostimulating implant subcutaneously at the epicentre of the painful area (target) rather than stimulating the peripheral nerves supplying it. It was first reported in 2003 and the first permanent implant case series followed in 20061. It is effective in treating chronic painful conditions of non-dermatomal distribution resulting in reduction of pain for varying duration. We are presenting an evaluation of our experience with permanent TS in the treatment of various chronic pain conditions. Methods: This iThis is a retrospective review of twenty one (21) patients with the permanent TS. Outcome measures analysed were pain and medication reduction, complications and stimulation parameters.Each implantation was preceded by external neuromodulation, temporary stimulating trial and pre-implantation pain management programme in that sequence as per the strict criteria of our Guy’s & St.Thomas’ Hospital Algorithm. Pain reduction of 50% and over during the trial qualified the patient for permanent implant. The permanent leads were implanted subcutaneously at the epicentre of pain for largest possible coverage. ANS and Medtronic systems were used. Results: 18 patients showed greater than 50% reduction in pain and significant reduction in analgesic use; 1 unit was removed due to infection; leads repositioned in 3; IPG repositioned in1. Majority showed significant reduction in analgesic use. Conclusions: TS is a new, promising technique. The approach to insert the stimulating lead(s) directly at the centre of pain subcutaneously is simple and effective. TS can be utilised as a sole procedure or in combination with peripheral or central stimulation. The outcome of this review supports our initial report.
Reference 1. Goroszeniuk T, Kothari S, Hamann W. Subcutaneous Neuromodulating Implant targeted at the site of pain; Reg Anaesth Pain Med 2006:31(2): 168-171.
477. Reflex sympathy dystrophy syndrome treatment and outcome J. Cruz, M. Barbosa, P. Pinto, I. Fonseca, M. Gouveia, J. Correia Chronic Pain Unit, Anesthesiology, Porto, Portugal Aim of Investigation: To evaluate the efficacy of conservative and invasive treatment in reflex sympathy dystrophy syndrome (RSDS) and define the epidemiological and clinical caracteristics of patients. Methods: Data analysis of the Chronic Pain Unit (CPU) patients suffering from RSDS, followed in our hospital between January 1997 and December 2007, were retrospectively reviewed. A telephone interview was conducted to evaluate the actual status of the patients. Non-parametric tests and Chi square were used to analyze data. Results: During this period 37 patients were followed (78%female). The mean age was 51 years (range 16-80). The incidence of RSDS was 1‰. RSDS Type I was 86%. 70% of RSDS were related to the upper limb. No statistically significant differences were found for patients with RSDS according to socio-demographic factors. All patients were under pharmacological treatment and 22 (60%) had multiple drug therapy. 11 patients were submitted to stellate ganglion block Fifteen patients (41%) were submitted to spinal cord stimulation, one (3%) patient with RSDS in the lower limb underwent intrathecal baclofen pump; all had total remission of pain and were asymptomatic. Neuromodulation therapy positively influenced pain and symptom control and reduced pharmacological treatment (p⬍ 0.05). Conclusions: Spinal cord stimulation seems to be the most efficient choice for RSDS treatment (pain and related signs and symptoms). Most likely, the total improvement of symptoms of RSDR in the one patient with baclofen might be due to the associated tonic dystonia, an uncommoncomplication of RSDS. The diversity of different treatments and their efficacy is dependent on an accurate and early diagnosis of pain, signs symptoms associated with RSDS.