title: Cervical Spinal Cord and Dorsal Nerve Root Stimulation for Neuropathic Upper Limb Pain.
abstract: BACKGROUND
  Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain in the lower limbs. Upper limb pain comprises a significant proportion of neuropathic pain patients, but is often difficult to target specifically and consistently with paresthesias. We hypothesized that the use of dorsal nerve root stimulation (DNRS), as an option along with SCS, would help us better relieve pain in these patients.
  
  
  METHODS
  All 35 patients trialed with spinal stimulation for upper limb pain between July 1, 2011, and October 31, 2013, were included. We performed permanent implantation in 23/35 patients based on a visual analogue scale pain score decrease of ≥50% during trial stimulation.
  
  
  RESULTS
  Both the SCS and DNRS groups had significant improvements in average visual analogue scale pain scores at 12 months compared with baseline, and the majority of patients in both groups obtained ≥50% pain relief. The majority of patients in both groups were able to reduce their opioid use, and on average had improvements in Short Form-36 quality of life scores. Complication rates did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  Treatment with SCS or DNRS provides meaningful long-term relief of chronic neuropathic pain in the upper limbs.
authors.affiliation: Department of Clinical Neurological Sciences,Division of Neurosurgery,Western University,London,ON,Canada.
authors.forename: Adrian B
authors.initials: AB
authors.lastname: Levine
authors.affiliation: Department of Clinical Neurological Sciences,Division of Neurosurgery,Western University,London,ON,Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Parrent
authors.affiliation: Department of Clinical Neurological Sciences,Division of Neurosurgery,Western University,London,ON,Canada.
authors.forename: Keith W
authors.initials: KW
authors.lastname: MacDougall
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D066193:Cervical Cord / Q000000981:diagnostic imaging / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000000981:diagnostic imaging / Q000628:therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000379:methods*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic Pain; Nerve Root Stimulation; Neuromodulation; Neurosurgery; Pain; Pain Control; Spinal Cord; Spinal Cord Stimulation