Spinal Cord Stimulation for Central Neuropathic Pain After Spinal Cord Injury: A Single-Center Case Series

Abstract

Paweł Sokal,1 Damian Palus,1 Magdalena Jabłońska,2 Oskar Puk,2 Sara Kieronska-Siwak1 1Department of Neurosurgery and Neurology, Faculty of Health Sciences, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85-168, Poland; 2Doctoral School Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, 85-168, PolandCorrespondence: Paweł Sokal, Department of Neurosurgery and Neurology, Faculty of Health Sciences, Collegium Medicum Nicolaus Copernicus University, Ujejskiego 75, Bydgoszcz, 85-168, Poland, Email [email protected]: Central neuropathic pain (CNP) following spinal cord injury (SCI) presents a formidable therapeutic challenge, affecting over 50% of the patients post-SCI. For those who experience CNP, conventional treatments often prove insufficient. Spinal cord stimulation (SCS) emerges as a potential intervention for chronic pain after SCI that is unresponsive to pharmacotherapy and supportive measures. However, the efficacy of SCS in alleviating CNP is notably limited. The objective of our study was to evaluate novel stimulation paradigms in SCS for patients with severe CNP after SCI, based on our extensive experience.Patients and Methods: From a pool of 112 patients treated with SCS for chronic neuropathic pain in the Department of Neurosurgery and Neurology, we selected eight individuals (4 males and 4 females) with CNP for our case series. Burst and high frequency SCS was applied. The assessment involved utilizing the Numeric Rating Scale (NRS), the Neuropathic Pain Symptom Inventory (NPSI), and the EQ-5D quality of life scale before surgery and during a 12-month follow-up period.Results: Over the course of the one-year follow-up, only two patients experienced satisfactory relief from pain, demonstrating the effectiveness of the stimulation. Moreover, high-frequency and burst SCS failed to show improvement in the remaining six patients.Conclusion: Our findings suggest that, despite the incorporation of new stimulation paradigms such as burst stimulation and high-frequency stimulation, SCS does not exhibit significant effectiveness in treating neuropathic pain in patients after SCI. These findings highlight the ongoing challenge of treating CNP and emphasize the importance of investigating alternative therapeutic strategies for this group.Keywords: spinal cord stimulation, central neuropathic pain, spinal cord injury, burst stimulation, high-frequency stimulation

Keywords

• spinal cord stimulation
• central neuropathic pain
• spinal cord injury
• burst stimulation
• high-frequency stimulation