The Usefulness of Spinal Cord Stimulation for Chronic Pain Due to Combined Vasospastic Prinzmetal Angina and Diabetic Neuropathic Pain of the Lower Limbs

Abstract

Objective To describe an unusual case of combined neuropathic and ischemia-induced chronic pain in a patient who was treated with one high thoracic paddle lead.

Background To the best of our knowledge, the use of spinal cord stimulation (SCS) utilizing a single lead as a treatment strategy for combined Prinzmetal angina, a cardiac ischemia-induced disturbance of nociceptive perception, and diabetic neuropathy of the lower limbs has rarely been described.

Case Report The underlying pain conditions and SCS technique used to treat both types of pain—Prinzmetal angina and lower-limb diabetic neuropathy—in a 73-year-old patient experiencing medical or interventional refractory complex pain syndrome are described. The SCS electrode was placed in the anatomical midline with a T2- to T3-level laminotomy and externalized for postoperative trial stimulation with systemic antibiotic administration.

Results After 8 months, stable pain control was achieved. No complications occurred.

Conclusion We present a chronic pain syndrome due to combined Prinzmetal angina and diabetic neuropathy of the lower limbs with sustained pain relief utilizing a single SCS lead.

Keywords

spinal cord stimulation - ischemic cardiac pain - diabetic neuropathy

• References

• 1 Kumar K, Rizvi S. Historical and present state of neuromodulation in chronic pain. Curr Pain Headache Rep 2014; 18 (1) 387
• 2 Pluijms WA, Slangen R, Bakkers M , et al. Pain relief and quality-of-life improvement after spinal cord stimulation in painful diabetic polyneuropathy: a pilot study. Br J Anaesth 2012; 109 (4) 623-629
• 3 DeJongste MJ, Foreman RD. Spinal cord stimulation for refractory angina. In: Krames E, Hunter Peckham P, Rezai AR, , eds. Neuromodulation. London, UK: Elsevier; 2009. :Chapter 69
• 4 Taylor RS, De Vries J, Buchser E, Dejongste MJ. Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovasc Disord 2009; 9: 13
• 5 Pluijms WA, Slangen R, Joosten EA , et al. Electrical spinal cord stimulation in painful diabetic polyneuropathy, a systematic review on treatment efficacy and safety. Eur J Pain 2011; 15 (8) 783-788
• 6 Tesfaye S, Watt J, Benbow SJ, Pang KA, Miles J, MacFarlane IA. Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy. Lancet 1996; 348 (9043) 1698-1701
• 7 Mironer YE, Satterthwaite JR, Lewis EM , et al. Efficacy of a single, percutaneous, across midline, Octrode® lead using a “midline anchoring” technique in the treatment of chronic low back and/or lower extremity pain: a retrospective study. Neuromodulation 2008; 11 (4) 286-295
• 8 Bendersky D, Yampolsky C. Is spinal cord stimulation safe? A review of its complications. World Neurosurg 2013; ; July 11 (Epub ahead of print)
• 9 Mearini M, Bergomi R, Panciani PP , et al. Dorsal paddle leads implant for spinal cord stimulation through laminotomy with midline structures preservation. Surg Neurol Int 2012; 3: 164
• 10 Deer TR, Mekhail N, Provenzano D , et al. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2014; 17 (6) 515-550 ; discussion 550