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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...

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Autores principales: Hoikkanen, Tomas, Nissen, Mette, Ikäheimo, Tiina-Mari, Jyrkkänen, Henna-Kaisa, Huttunen, Jukka, von und zu Fraunberg, Mikael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
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.
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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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