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http://dx.doi.org/10.3344/kjp.2016.29.2.123

Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome -A Case Report-  

Lee, Pil Moo (Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine)
So, Yun (Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine)
Park, Jung Min (Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine)
Park, Chul Min (Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine)
Kim, Hae Kyoung (Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine)
Kim, Jae Hun (Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine)
Publication Information
The Korean Journal of Pain / v.29, no.2, 2016 , pp. 123-128 More about this Journal
Abstract
Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.
Keywords
Cauda equina; Lower extremity pain; Neurostimulation; Phantom limb; Phantom limb pain; Spinal cord stimulation;
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Times Cited By KSCI : 5  (Citation Analysis)
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1 Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol 2002; 1: 182-9.   DOI
2 Kim SY, Kim YY. Mirror therapy for phantom limb pain. Korean J Pain 2012; 25: 272-4.   DOI
3 Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 2005; 86: 1910-9.   DOI
4 Nielson KD, Adams JE, Hosobuchi Y. Phantom limb pain. Treatment with dorsal column stimulation. J Neurosurg 1975; 42: 301-7.   DOI
5 Kooijman CM, Dijkstra PU, Geertzen JH, Elzinga A, van der Schans CP. Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 2000; 87: 33-41.   DOI
6 Lee KH, Lee SE, Jung JW, Jeon SY. Spinal cord stimulation for intractable visceral pain due to sphincter of oddi dysfunction. Korean J Pain 2015; 28: 57-60.   DOI
7 Jeon YH. Spinal cord stimulation in pain management: a review. Korean J Pain 2012; 25: 143-50.   DOI
8 Wolter T. Spinal cord stimulation for neuropathic pain: current perspectives. J Pain Res 2014; 7: 651-63.
9 Houghton AD, Nicholls G, Houghton AL, Saadah E, McColl L. Phantom pain: natural history and association with rehabilitation. Ann R Coll Surg Engl 1994; 76: 22-5.
10 Weeks SR, Anderson-Barnes VC, Tsao JW. Phantom limb pain: theories and therapies. Neurologist 2010; 16: 277-86.   DOI
11 Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010; 9: 807-19.   DOI
12 Woodhouse A. Phantom limb sensation. Clin Exp Pharmacol Physiol 2005; 32: 132-4.   DOI
13 Sherman RA, Sherman CJ, Gall NG. A survey of current phantom limb pain treatment in the United States. Pain 1980; 8: 85-99.   DOI
14 Ramachandran VS, Hirstein W. The perception of phantom limbs. The D. O. Hebb lecture. Brain 1998; 121: 1603-30.   DOI
15 Ramachandran VS, Stewart M, Rogers-Ramachandran DC. Perceptual correlates of massive cortical reorganization. Neuroreport 1992; 3: 583-6.   DOI
16 Shin JH, Kim YC, Jang IK, Kim JH, Park SY, Lee SC. Occipital nerve stimulation in a patient with an intractable chronic headache: a case report. Korean J Anesthesiol 2011; 60: 298-301.   DOI
17 Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci 2006; 7: 873-81.
18 Eldabe S, Burger K, Moser H, Klase D, Schu S, Wahlstedt A, et al. Dorsal root ganglion (DRG) stimulation in the treatment of phantom limb pain (PLP). Neuromodulation 2015; 18: 610-6.   DOI
19 George AT, Dudding TC, Gurmany S, Kamm MA, Nicholls RJ, Vaizey CJ. Pudendal nerve stimulation for bowel dysfunction in complete cauda equina syndrome. Ann Surg 2014; 259: 502-7.   DOI
20 Verrills P, Russo M. Peripheral nerve stimulation for back pain. Prog Neurol Surg 2015; 29: 127-38.
21 Park CH, Kim BI. Sacral nerve stimulation through the sacral hiatus. Korean J Pain 2012; 25: 195-7.   DOI
22 Alo KM, Yland MJ, Redko V, Feler C, Naumann C. Lumbar and sacral nerve root stimulation (NRS) in the treatment of chronic pain: a novel anatomic approach and neuro stimulation technique. Neuromodulation 1999; 2: 23-31.   DOI
23 Alo KM, Holsheimer J. New trends in neuromodulation for the management of neuropathic pain. Neurosurgery 2002; 50: 690-703.   DOI
24 Takiguchi T, Yamaguchi S, Tezuka M, Kitajima T. Measurement of shift of the cauda equina in the subarachnoid space by changing position. Reg Anesth Pain Med 2009; 34: 326-9.   DOI