title: Technical aspects of spinal cord stimulation for managing chronic visceral abdominal pain: the results from the national survey.
abstract: BACKGROUND, OBJECTIVES, AND METHODS: A few recent reports suggested that spinal cord stimulation (SCS) effectively suppresses chronic abdominal pain. However, there is no consensus on patient selection or technical aspects of SCS for such pain. That is why we conducted national survey and collected 76 case reports. There were six incompletely filled reports, so we analyzed 70 cases.
  
  
  RESULTS
  There were 43 female and 27 male patients. SCS was trialed in an average of 4.7 days (median of 4 days). In most patients, the leads were positioned for the SCS trial with their tips at the level of the T5 vertebral body (26 patients) or T6 vertebral body (15 patients). Four patients failed SCS trial: their average baseline visual analog scale (VAS) pain score was 7 +/- 2.4 cm and did not improve at the conclusion of the trial (6.5 +/- 1.9 cm; P = 0.759). Pain relief exceeded 50% in 66 of 70 patients reported. Among those, VAS pain score before the trial averaged 7.9 +/- 1.8 cm. During the trial VAS pain scores decreased to 2.45 +/- 1.45 cm (P < 0.001). The opioid use decreased from 128 +/- 159 mg of morphine sulfate equivalents a day to 79 +/- 112 mg (P < 0.017). During permanent implantation most of the physicians used two octrode leads and were positioned midline at T5-6 levels. The average patient follow-up was 84 weeks. VAS pain scores before an implant were 8 +/- 1.9 cm, while after the implant 2.49 +/- 1.9 cm. The opioid use before an implant was 158 +/- 160 mg and at the last office visit after the implant 36 +/- 49 mg.
  
  
  CONCLUSIONS
  In conclusion, it seems that the SCS for the treatment of the abdominal visceral pain may provide a positive patient long-term experience, significant improvements in pain scores and a decrease in opioid use.
authors.affiliation: Department of Pain Management, Cleveland Clinic, Cleveland, Ohio 44195, USA. kapural@ccf.org
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.forename: Timothy
authors.initials: T
authors.lastname: Deer
authors.forename: Alexandar
authors.initials: A
authors.lastname: Yakovlev
authors.forename: Toula
authors.initials: T
authors.lastname: Bensitel
authors.forename: Salim
authors.initials: S
authors.lastname: Hayek
authors.forename: Stephen
authors.initials: S
authors.lastname: Pyles
authors.forename: Yasin
authors.initials: Y
authors.lastname: Khan
authors.forename: Alberta
authors.initials: A
authors.lastname: Kapural
authors.forename: Dondre
authors.initials: D
authors.lastname: Cooper
authors.forename: Lisa
authors.initials: L
authors.lastname: Stearns
authors.forename: Paulina
authors.initials: P
authors.lastname: Zovkic
mesh_terms: D015746:Abdominal Pain / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D013116:Spinal Cord / Q000502:physiology*; D011795:Surveys and Questionnaires; D014781:Viscera / Q000503:physiopathology* / Q000601:surgery; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid