Open AccessSpinal Cord Stimulation for Treatment of Pain in a Patient with Post Thoracotomy Pain Syndrome
Author(s) -
Jordan Graybill
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/441
Subject(s) - medicine , anesthesia , thoracotomy , pulsed radiofrequency , spinal cord stimulator , surgery , intercostal nerves , transcutaneous electrical nerve stimulation , chronic pain , referred pain , neuropathic pain , spinal cord , spinal cord stimulation , physical therapy , pain relief , alternative medicine , pathology , psychiatry
Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the areaof the thoracotomy incision for at least 2 months following the initial procedure. The trueincidence of PTPS is hard to define as literature reports a wide range of occurrence from 5%to 90%. Thoracotomy is associated with a high risk of severe chronic postoperative pain.Presenting symptoms include both neuropathic pain in the area of the incision, as well asmyofascial pain commonly in the ipsilateral scapula and shoulder.Pain management can be challenging in these patients. Multiple treatments have beendescribed including conservative treatments with oral nonsteroidal anti-inflammatory drugs(NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physicaltherapy; transcutaneous electrical nerve stimulation as well as more invasive treatmentsincluding intercostal nerve blocks, trigger point steroid injections, epidural steroid injections,radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatmentmodalities, and in some cases will experience worsening of pain.This case report describes the novel utility and complete resolution of symptoms with spinalcord stimulation (SCS) in treatment of a patient with persistent PTPS.In the operating room, a percutaneous octet electrode lead was placed using sterile techniqueunder fluoroscopic guidance and loss-of-resistance technique. The octet electrode lead wassubsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplatejust right of midline. The patient’s pain distribution was captured optimally with stimulationat this level. With the assistance of a neurosurgeon, the lead was anchored, tunneled, andconnected to a generator, which was implanted over the right iliac crest. The patient toleratedthe procedure well with no complications.We report the successful use of SCS as well as complete resolution of symptoms at 4 monthsfollow-up, in a patient with persistent PTPS, which was resistant to other modalities.In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted.Key words: post thoracotomy pain syndrome, PTPS, chronic pain, spinal cord stimulation,thoracic pain, neuropathic pain, transcranial magnetic stimulation