title: Spinal cord stimulation for visceral pain from chronic pancreatitis.
abstract: OBJECTIVE
  Spinal cord stimulation (SCS) may reduce pain scores and improve function in patients with various chronic abdominal pain syndromes including chronic pancreatitis. Here described is a large clinical experience in SCS for severe chronic pancreatitis.
  
  
  METHODS
  SCS was trialed in 30 patients with chronic pancreatitis. SCS trials lasted 7-14 days (median 9 days). SCS lead tips were mostly positioned at the T5 (N= 10) or T6 (N= 10) vertebral level.
  
  
  RESULTS
  Twenty-four patients (80%) reported at least 50% pain relief on completion of the trial. Among these, pre-trial visual analog scale (VAS) pain scores averaged 8 ± 1.6 (standard deviation) and opioid use averaged 165 ± 120 mg morphine sulfate equivalents. During the trial, VAS pain scores decreased to 3.67 ± 2 cm (p < 0.001, Mann-Whitney Rank Sum Test) and opioid use decreased to 105 ± 101 mg morphine equivalent a day. Six patients failed the trial; one was lost to follow-up; in three patients after the implantation, the system had to be removed due to infection or lead migration; and 20 were followed for the whole year. For 20 patients followed for the whole year, VAS pain scores remained low (3.6 ± 2 cm; p < 0.001) at one year, as did opioid use (48.6 ± 58 mg morphine equivalents).
  
  
  CONCLUSIONS
  SCS may be a useful therapeutic option for patients with severe visceral pain from chronic pancreatitis. Prospective trial is warranted.
authors.affiliation: Pain Management Department, Anesthesia Institute, Cleveland Clinic, Cleveland, Ohio, USA. lkapural@ccrpain.com
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.forename: Jacek B
authors.initials: JB
authors.lastname: Cywinski
authors.forename: Dawn A
authors.initials: DA
authors.lastname: Sparks
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000502:physiology*; D059265:Visceral Pain / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*