Document Detail


Failure of long-term nerve root stimulation to improve neuropathic pain.
MedLine Citation:
PMID:  18447707     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Stimulation of dorsal nerve roots or dorsal root ganglia was reported to alleviate neuropathic pain in selected patients during the early postoperative period. A prospective study was initiated to investigate long-term outcome in patients with neuropathic pain of the lower extremities or groin who were treated with selective nerve root stimulation. METHODS: The study included patients with dermatomally distributed neuropathic pain who were > 18 years of age and in whom the pain was refractory to medical treatment. The patients were prospectively evaluated using a visual analog scale (VAS) for pain and ratings for quality of life, activities of daily living, and depression preoperatively, and after defined intervals postoperatively. Implantation of electrodes was performed via foraminotomy or interlaminar fenestration in an awake procedure. An implantable pulse generator (IPG) was implanted in a second operation after successful test stimulation performed over several days. RESULTS: Three patients were included in the study before it was stopped. The mean maximum pain score preoperatively was 9.3. All patients had successful test stimulation with > 50% pain relief prior to implantation of the IPG (mean maximum VAS Score 3.6). The beneficial effect, however, was lost within the next few months despite adjustment of stimulation settings. With higher amplitudes, side effects such as pain attacks or motor phenomena occurred. They disappeared after stopping stimulation, but neuropathic pain recurred to its full extent. The study was stopped 18 months after the first implantation, when the third and last IPG of this series was explanted. Due to the overall short-term effect of stimulation, no relevant changes in ratings for quality of life, activities of daily living, or depression were detected. CONCLUSIONS: Spinal nerve root stimulation proved to be effective on short-term follow-up in 3 patients with neuropathic pain in a dermatomal distribution. Long-term stimulation, however, was disappointing because of the loss of effectiveness and the occurrence of side effects.
Authors:
Ralf Weigel; Hans-Holger Capelle; Joachim K Krauss
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  108     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-01     Completed Date:  2008-06-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  921-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, University Hospital Mannheim, Germany.
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MeSH Terms
Descriptor/Qualifier:
Aged
Electric Stimulation Therapy / methods*
Female
Humans
Leg / innervation
Male
Middle Aged
Neuralgia / therapy*
Pain Measurement
Prospective Studies
Quality of Life
Spinal Nerve Roots*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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