title: Spinal cord stimulation for treatment of the pain associated with hereditary multiple osteochondromas.
abstract: OBJECTIVE
  Hereditary multiple osteochondromas (HMO) usually presents with neoplastic lesions throughout the skeletal system. These lesions frequently cause chronic pain and are conventionally treated with surgical resection and medication. In cases where conventional treatments have failed, spinal cord stimulation (SCS) could be considered as a potential option for pain relief. The objective of this case was to determine if SCS may have a role in treating pain secondary to neoplastic lesions from HMO.
  
  
  METHODS
  We report a 65-year-old female who previously received both surgical and pharmacological interventions for treating HMO neoplastic pain in the lumbar, pelvis, femur, and tibial regions. These interventions either failed to offer significant pain relief or caused excessive lethargy. A SCS trial was then offered with a dual 16-contact lead trial leading to 70%-80% improvement in pain from baseline and 85% reduction in oxycodone IR intake. This was followed by permanent implantation of two 2×8 contact paddle leads (T7-T8 and T9-T10 interspaces). After 8-week follow-up, settings were further optimized resulting in an additional 30% improvement in pain compared to last visit. At 6-month follow-up, the patient reported continued pain relief.
  
  
  CONCLUSIONS
  This case demonstrates the first successful use of SCS to treat both HMO and nonmalignant neoplastic-related pain. The patient reported pain improvement from baseline, reduced pain medication requirements, and subjective improvement in quality of life. Additionally, this case demonstrates the potential advantage of trialing multiple painful areas with a 16-contact lead in order to avoid multiple trials and placement.
authors: Department of Physical Medicine and Rehabilitaiton, University of California Irvine, Irvine, CA, USA.
authors: Ravi G
authors: RG
authors: Mirpuri
authors: Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA.
authors: Jereme
authors: J
authors: Brammeier
authors: Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA.
authors: Hamilton
authors: H
authors: Chen
authors: Department of Physical Medicine and Rehabilitaiton, University of California Irvine, Irvine, CA, USA ; Department of Neurological Surgery, University of California Irvine, Irvine, CA, USA.
authors: Frank Pk
authors: FP
authors: Hsu
authors: Department of Medicine, University of California Irvine, Irvine, CA, USA.
authors: Vi K
authors: VK
authors: Chiu
authors: Department of Physical Medicine and Rehabilitaiton, University of California Irvine, Irvine, CA, USA ; Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, USA ; Reeve-Irvine Research Center for Spinal Cord Injury, University of California Irvine, Irvine, CA, USA.
authors: Eric Y
authors: EY
authors: Chang
keywords: Exostoses; back pain/therapy; bone neoplasms/pathology; case reports; chronic pain; hereditary exostoses/multiple; pain management; spinal cord stimulation; treatment outcome