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Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome
BACKGROUND: Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven. OBJECTIVE: To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440061/ https://www.ncbi.nlm.nih.gov/pubmed/34245150 http://dx.doi.org/10.1093/neuros/nyab239 |
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author | Hoikkanen, Tomas Nissen, Mette Ikäheimo, Tiina-Mari Jyrkkänen, Henna-Kaisa Huttunen, Jukka von und zu Fraunberg, Mikael |
author_facet | Hoikkanen, Tomas Nissen, Mette Ikäheimo, Tiina-Mari Jyrkkänen, Henna-Kaisa Huttunen, Jukka von und zu Fraunberg, Mikael |
author_sort | Hoikkanen, Tomas |
collection | PubMed |
description | BACKGROUND: Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven. OBJECTIVE: To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in opioid and neuropathic pain medication use over a 4-yr follow-up. METHODS: We retrospectively reviewed all medical records of 35 consecutive CRPS patients who underwent SCS trials at 2 hospitals during January 1998 to December 2016. The purchase data of opioids and neuropathic pain medication during January 1995 to March 2016 were retrieved from national registries. RESULTS: Based on a 1-wk trial, permanent SCS was implanted in 27 (77%) patients. During the median follow-up of 8 yr, 8 (30%) SCS devices were explanted, of which 7 were because of inefficient pain relief. Complications leading to revision occurred in 17 (63%) patients: 8 electrode migrations or stimulation to the wrong area, 1 deep infection, 9 hardware malfunctions, 2 pulse generator discomforts, and 2 SCS replacements. None of the 6 patients using strong opioids discontinued their use during the 2-yr follow-up. The mean opioid dose increased nonsignificantly both in patients with SCS in permanent use (53 ± 150 morphine milligram equivalents morphine milligram equivalent (MME)/day to 120 ± 240 MME/day) and in patients who had SCS explanted (27 ± 72 MME/day to 57 ± 66 MME/day). CONCLUSION: Despite the fact that CRPS patients were not able to discontinue or reduce their strong opioid or neuropathic pain medication use, 70% continued to use their SCS device during a median 8-yr follow-up. |
format | Online Article Text |
id | pubmed-8440061 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-84400612021-09-15 Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome Hoikkanen, Tomas Nissen, Mette Ikäheimo, Tiina-Mari Jyrkkänen, Henna-Kaisa Huttunen, Jukka von und zu Fraunberg, Mikael Neurosurgery Research—Human—Clinical Studies BACKGROUND: Spinal cord stimulation (SCS) is an effective treatment in chronic neuropathic pain, but its efficacy in complex regional pain syndrome (CRPS) needs to be proven. OBJECTIVE: To study the outcome of SCS in CRPS as measured by trial success, explantation rate, complications, and changes in opioid and neuropathic pain medication use over a 4-yr follow-up. METHODS: We retrospectively reviewed all medical records of 35 consecutive CRPS patients who underwent SCS trials at 2 hospitals during January 1998 to December 2016. The purchase data of opioids and neuropathic pain medication during January 1995 to March 2016 were retrieved from national registries. RESULTS: Based on a 1-wk trial, permanent SCS was implanted in 27 (77%) patients. During the median follow-up of 8 yr, 8 (30%) SCS devices were explanted, of which 7 were because of inefficient pain relief. Complications leading to revision occurred in 17 (63%) patients: 8 electrode migrations or stimulation to the wrong area, 1 deep infection, 9 hardware malfunctions, 2 pulse generator discomforts, and 2 SCS replacements. None of the 6 patients using strong opioids discontinued their use during the 2-yr follow-up. The mean opioid dose increased nonsignificantly both in patients with SCS in permanent use (53 ± 150 morphine milligram equivalents morphine milligram equivalent (MME)/day to 120 ± 240 MME/day) and in patients who had SCS explanted (27 ± 72 MME/day to 57 ± 66 MME/day). CONCLUSION: Despite the fact that CRPS patients were not able to discontinue or reduce their strong opioid or neuropathic pain medication use, 70% continued to use their SCS device during a median 8-yr follow-up. Oxford University Press 2021-07-09 /pmc/articles/PMC8440061/ /pubmed/34245150 http://dx.doi.org/10.1093/neuros/nyab239 Text en © Congress of Neurological Surgeons 2021. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Research—Human—Clinical Studies Hoikkanen, Tomas Nissen, Mette Ikäheimo, Tiina-Mari Jyrkkänen, Henna-Kaisa Huttunen, Jukka von und zu Fraunberg, Mikael Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome |
title | Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome |
title_full | Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome |
title_fullStr | Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome |
title_full_unstemmed | Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome |
title_short | Long-Term Outcome of Spinal Cord Stimulation in Complex Regional Pain Syndrome |
title_sort | long-term outcome of spinal cord stimulation in complex regional pain syndrome |
topic | Research—Human—Clinical Studies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440061/ https://www.ncbi.nlm.nih.gov/pubmed/34245150 http://dx.doi.org/10.1093/neuros/nyab239 |
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