Spinal cord stimulation for central poststroke pain.
BACKGROUND
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 (> or =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.


CONCLUSIONS
SCS may provide improved pain control in a group of patients with intractable CPSP and may have therapeutic potential for intractable CPSP.
Aly
Mohamed M
MM
Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Saitoh
Youichi
Y
Hosomi
Koichi
K
Oshino
Satoru
S
Kishima
Haruhiko
H
Yoshimine
Toshiki
T
D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D012189:Retrospective Studies; D013116:Spinal Cord / Q000502:physiology*; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome