疼痛管理と医学ジャーナル

概要

Cervical spinal cord stimulation for the treatment of intractable neuropathic pain due to brachial plexopathy – a report of three failed cases

Lucia Lopez MD and Andrei Sdrulla MD PhD

Pain caused by brachial plexus neuropathy (BPN) represents a challenging clinical problem with few effective therapeutic options, and spinal cord stimulation (SCS) has emerged as a potential treatment modality. Although early case reports had described mostly negative outcomes, multiple recent publications detailed the successful use of SCS in patients with traumatic BPN. Here we present three cases of painful BPN who failed conservative treatments and underwent trials of cervical SCS. The first case had radiation-therapy induced BPN with involvement of the upper trunk, the second had Pancoast tumor treatment-related BPN of the lower trunk, and the third suffered BPN of the entire plexus following trauma. Unfortunately, none of the patients reported greater than 30-40% pain reduction during the SCS trials despite extensive programming efforts and use of novel stimulation waveforms, and none proceeded to implantation. Additional research is needed to determine the role of SCS in patients with BPN.