Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis.
Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronic pain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. Previous therapies included numerous endoscopic retrograde cholangiopancreatographies, multiple pancreatic duct stenting, chemical and surgical sympathectomies with short-lasting pain relief. After the initial evaluation, the patient underwent retrograde epidural differential block to determine possible source of pain. Delay in pain recurrence after block suggested that the origin of her pain was visceral. After the psychologic evaluation, the patient underwent SCS trial over 14 days. She had 2 trial leads placed epidurally via T9-T10 paramedian entry with the tips of both leads positioned at T6 vertebral body. During the trial, visual analog scale pain score decreased from 8 to 1 cm, Pain Disability Index from 62 to 14, and opioid use from 150 to 0 mg of morphine sulfate equivalent a day. After the completion of successful SCS trial, she was implanted with dual octrode leads and rechargeable pulse generator. Median pain scores decreased from 8 to 1 at 3 months after the implant. Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis.
Kapural
Leonardo
L
Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Rakic
Mladen
M
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000818:Animals; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D010147:Pain Measurement; D050500:Pancreatitis, Chronic / Q000150:complications*; D013116:Spinal Cord / Q000378:metabolism*; D017833:Visceral Afferents / Q000378:metabolism