Spinal Cord Stimulation for Central Poststroke Pain

Abstract

AbstractBACKGROUND:Although spinal cord stimulation (SCS) has been shown to be effective for treating neuropathic pain of peripheral origin, its effectiveness for central poststroke pain (CPSP) is not well established.OBJECTIVE:We report our experience with SCS in 30 consecutive patients with intractable CPSP.METHODS:All patients underwent a percutaneous SCS trial. When patients decided to proceed, they received a permanent SCS system. Pain intensity was evaluated by a visual analogue scale (VAS). The Patient Global Impression of Change (PGIC) scale was also assessed at the latest follow-up visit as an indicator of overall improvement.RESULTS:During trial stimulation, pain relief was good (≥50% VAS score reduction) in 9 patients (30%), fair (30%–49% reduction) in 6 patients (20%), and poor (<30% reduction) in 15 patients (50%). Ten patients elected to receive a permanent SCS system. Nine of these 10 patients were followed long-term (mean, 28 months; range, 6–62 months). Seven patients reported significant pain relief on the VAS (5 = good and 2 = fair). On the PGIC scale, 6 of these 7 patients reported a rating of 2 (much improved) and 1 reported a rating of 3 (minimally improved). Of the remaining 2 patients, 1 reported a rating of 4 (no change) and 1 reported a rating of 5 (minimally worse). The median VAS score in the 9 patients decreased significantly from 8.6 (range, 6.0–10.0) to 4.5 (range, 3.0–8.0; P= .008). There were no significant reported complications.CONCLUSION:SCS may provide improved pain control in a group of patients with intractable CPSP and may have therapeutic potential for intractable CPSP.