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Spinal Cord Stimulation: Benefiting Neuropathic Pain Patients

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One of the hardest pain syndromes to treat is neuropathic pain. There have been developments aimed at helping patients with neuropathic pain. Different types of treatment have been developed, ranging from conventional, conservative pain relief with medication, through to surgery. A recent international study published in the journal Pain trialled a technique called spinal cord stimulation, or SCS, in combination with conventional medical management (CMM) to determine whether it is effective in relieving pain for sufferers. Spinal cord stimulation works by stimulating the affected nerves, ‘distracting’ them so that the patient does not ‘feel’ the pain. The study found that SCS combined with conventional medical management (such as medications) is proving to be a promising and beneficial treatment for patients who have had failed back surgery and suffer from neuropathic pain as a result.

Neuropathic pain is described as pains resulting from disease or damage of the certain nerves in the body, or from dysfunction of these nerves.

There are a variety of causes of neuropathic pain, ranging from trauma to pressure on the nerves. Other common conditions such as diabetes or long-term alcohol use can also cause neuropathic pain. This can affect all of the nerves in the body, leading to severe pain that can cause great stress and discomfort.

It is often very difficult for people to describe the neuropathic pain they are experiencing; it can be unlike any pain you have ever felt before. Therefore, doctors can often find it difficult to completely treat the pain. Apart from the pain, changes to sensations can also occur.

There are many different options for treating neuropathic pain. For example, if pain is mainly caused by something pressing on a nerve, surgery can provide relief for the nerve by removing the object. This is particularly useful if there has been little damage to the actual nerve itself.

Commonly used treatments are medications. Medications that many doctors use regularly include anticonvulsants, antidepressants and local anaesthetics. (For a complete list, please see end of article).

However, the pain may be persistent and severe even if only minor damage has been done to the nerve. Therefore, the realistic treatment goal for the majority of sufferers of neuropathic pain is adequate pain relief, achieved with medications, and an improvement in mobility.

New therapies have been sought and developed to treat this severe condition. In a recent large study published in the journal Pain, the technique of spinal cord stimulation was studied and proven to be an effective treatment option when combined with conventional medical management for patients having failed back surgery syndrome, or FBSS. Spinal cord stimulation achieves its effect of pain relief by stimulating the nerves affected of the spinal cord, ‘distracting’ it so that the patient does not ‘feel’ the pain.

In the study, 100 patients with FBSS received either conventional medical management alone, or conventional medical management (CMM) and spinal cord stimulation (SCS). The patients received treatment for at least 6 months. The study measured pain relief as well as improvements in quality of life, ease of moving about and use of pain medications.

48% of the SCS group achieved at least a 50% reduction in their pain levels compared with 9% of the CMM group. As patients in the trial were allowed to switch over to another group after 6 months, 32 from the CMM group chose to switch to the SCS group, whereas only 5 patients went to the CMM group. SCS is considered a relatively safe procedure. 32% of patients experienced some form of machine related problem, which is a consistent and acceptable level.

From this study, it appears that in selected patients, SCS combined with CMM provides pain relief and improves health-related quality of life. In contrast, CMM alone provided little or no pain relief or other outcome benefit.

This is promising information for sufferers of neuropathic pain. However it is advised that you consult with your medical practitioner about any therapies, as your individual circumstance may be different than to those mentioned in this article.

Recognised Treatments for Neuropathic Pain

Surgical

Decompression:

  • Surgery to relieve impingement on affected area

Non-surgical

Local treatment:

  • Transcutaneous electrical stimulation (TENS)
  • Massage
  • Thermal (heat/cold)
  • Acupuncture

Central nerve stimulation

  • Spinal cord stimulation
  • Deep brain stimulation

Medications:

Anticonvulsants

  • Pregabalin
  • Gapapentin
  • Sodium Valproate
  • Carbamazepine
  • Phenytoin

Antidepressants

  • Tricyclic antidepressants (for example: amitriptyline, nortriptyline)
  • SSRIs (e.g. sertraline, paroxetine, citalopram)

Analagesics

  • Paracetamol
  • NSAIDs
  • Opiates

Anaesthetics

  • Local anaesthetic
  • Nerve blocks
  • Epidural

Other

  • Topical Capsaicin

Psychological therapies:

  • Rehabilitation
  • Hypnosis
  • Behavioural programmes

References:

  1. Kumar K, Taylor RS, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 2007; 132: 179-88.
  2. Scadding J. Neuropathic Pain. ACNR 2003; 3(2): 8-14.
  3. Kumar P, Clark M. Clinical Medicine, 5th Ed, 2003, WB Saunders, London.
  4. Grond S, Radbruch L, Meuser T, et al. Assessment and treatment of neuropathic cancer pain following WHO guidelines. Pain 1999; 79(1): 15-20.
  5. Stute P, Soukoup J, Menzel M, et al. Analysis and treatment of different types of neuropathic cancer pain. J Pain Sym Man 2003; 26(6): 1123-31.
  6. Barolat G.. Spinal Cord Stimulation for Chronic Pain Management. Arch Med Res 2000; 31(3): 258-62.
  7. Harney D, Magner JJ, O’Keeffe D. Complex regional pain syndrome: the case for spinal cord stimulation (a brief review). Injury 2005; 36(3): 357-62.
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Dates

Posted On: 14 January, 2008
Modified On: 16 January, 2014

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