Spinal Cord Stimulation for Visceral Pain

ABSTRACT

MAIN SUPPORTING RESEACH

ROAD BLOCKS

Many individuals suffer from chronic abdominal pain where it has become a common complaint in primary care. Visceral pain can original from one or more of the internal organs. There are many somatic and visceral inputs which have been know to trigger motor and autonomic reflexes for a reaction. This reaction can be interpreted as a warning system

Patient Selection

DISCUSSION

PROCEDURE

Spinal Cord Stimulation (SDS)
Dorsal Column Stimulation (DCS)

to qualify individuals need to have either dermatomal hyperalgesia or have been previously treated with SCS for sympathetically mediated neuropathic abdominal pain

used to treat visceral pain .. chest / abdominal / intestinal / pelvic

positive results, with baselines dropping more than half.

there has been successful treatments at the Leeds Pain and Neuromodulation Centre since 1995

can be difficult to cure all pain as acute pain exists

key reasoning: "find dermatomal allodynia or hyperalgesia consistent with the area of pain" OR "greater reduction of pain after coeliac plexus block"

Paresthesia, unwanted muscle spasms as a response to stimulating the ventral fibers

high doses of morphine (above 720 mg) can inhibit procedure

placing electrodes at:
T9/10 [abdominal pain]
T10/11-T11/12[lower abdominal pain]

using a curved tip introducer to aid insertion, but aimed to keep entry as lateral as possible

Quality of life increased from ability to do things and mood

study took place over 26 months, which is prolonged. Thus, results are more reliable than a one time study

Median Morphine dose dropped from 160 mg to 26 mg. "Overall 75% reduction in anti-neuropathic drugs"

There are some pathways (vertical and descending) which DCS cannot activate where SCS can

Gap junctions in the Dorsal Root Ganglion (DRG) can linger post inflammation - shown in some animals. This can help understand the complexity of pain treatment

previous studies focused heavily on dorsal column, where this study includes sympathetic efferent as a 'stimulus release' as well. As the Cathods are placed in the ventral space near the sympathetic efferent there could be some connection

it can more difficult to see results for individuals on high doses of morphine (720 mg or above). this does not unqualify them for treatment but the results cannot be guaranteed to happen in the same timeframe.