title: Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.
abstract: Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale.
authors.affiliation: Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy. Electronic address: gdecaridi@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Caridi
authors.affiliation: Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Massara
authors.affiliation: Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Serra
authors.affiliation: Anesthesiological Sciences Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Risitano
authors.affiliation: Anesthesiological Sciences Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Giardina
authors.affiliation: Cardiovascular and Thoracic Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy.
authors.forename: Ignazio Eduardo
authors.initials: IE
authors.lastname: Acri
authors.affiliation: Vascular and Endovascular Department, Ospedali Riuniti Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Volpe
authors.affiliation: Anesthesiological Sciences Department, "Policlinico G. Martino" Hospital, University of Messina, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: David
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D010147:Pain Measurement; D010591:Phantom Limb / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000295:instrumentation; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid