title: Spinal cord stimulation (SCS) in conjunction with peripheral nerve field stimulation (PNfS) for the treatment of complex pain in failed back surgery syndrome (FBSS).
abstract: BACKGROUND
  Failed back surgery syndrome (FBSS) is a well-defined pathologic condition observed over many years.
  
  
  METHODS
  We have investigated the effect of spinal cord stimulation (SCS) with peripheral nerve field stimulation (PNfS) in eight patients with FBSS.
  
  
  METHODS
  The following parameters were collected and analyzed: The pain intensity score on a 0-10 numbering rating scale (NRS), the psychologic profile with Beck Depression Inventory (BDI), the pain quality with McGill Pain Questionnaire-short form (MGPQ-sf), the back pain with Oswestry scale score (OS), and the health general quality pattern with QualityMetric's SF-36v2(®) Health Survey.
  
  
  METHODS
  Eight patients with low back and radicular pain in FBSS are reported. The mean duration of pain was 6.7 months, and the mean NRS score was 9.5, BDI 28.8, MGPQ-sf 16.8, OS 44.5, and SF-36 score was 72.8. The average drug intake of opioids was 250 mg/day.
  
  
  METHODS
  In six patients, two octopolar leads were placed in epidural space at D7-D8 and D8-D9, in conjunction with two octopolar leads placed in lumbar-sacral subcutaneous space (Precision System, Boston Scientific, Valencia, CA, USA), and in two patients, a two tetrapolar leads was placed in epidural space at D8-D9 with two tetrapolar leads (Pisces Quad, Plus, Medtronic Inc., Minneapolis, MN, USA) placed in lumbar-sacral subcutaneous space (Restore Ultra, Medtronic Inc., Minneapolis, MN, USA).
  
  
  RESULTS
  After one year mean of follow-up, the mean NRS score was 4, BDI 8, MGPQ-sf 5, OS 21, and the SF-36 score was increased at 108.5. The mean drug intake of opioids was decreased at 20 mg/day.
  
  
  CONCLUSIONS
  The combination of SCS and PNfS, using the latest rechargeable systems, may be a valid therapeutic strategy in FBSS.
authors.affiliation: Pain Therapy Department, Oglio-Po Hospital, Casalmaggiore, Italy. c.reverberi@gmail.com
authors.forename: Claudio
authors.initials: C
authors.lastname: Reverberi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Dario
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Barolat
mesh_terms: D055111:Failed Back Surgery Syndrome / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017933:Peripheral Nervous System / Q000502:physiology; D062187:Spinal Cord Stimulation / Q000295:instrumentation / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000295:instrumentation / Q000379:methods*