İskemik Ağrıda Spinal Kord Stimülasyonu: Olgu Serisi

Öz

ÖZ Amaç Kronik ağrı tedavisinde, girişimsel yöntemler içinde nöromodülasyon teknikleri önemli bir yer tutmaktadır. Spinal Kord Stimülasyonu (SKS), nöromodülasyon teknikleri arasında en sık uygulanan tedavi yöntemidir. SKS işlemi, İskemik ağrı, yetersiz bel cerrahisi, nöropatik ağrı ve kanser ağrısında kullanılabilen bir nöromodulasyon yöntemidir. Çalışmamızda, periferik damar hastalığına (PDH bağlı, alt ekstremitede iskemik kronik ağrı tanısı olan hastalarla, SKS’nin ağrı şiddetine etkileri araştırıldı. Gereç ve Yöntemler SKS yerleştirilmiş olan 10 hastanın Nisan 2020-Nisan 2024 arasındaki medikal kayıtları incelendi.. Hastaların ikisinde (%20) kronik anjina pektorise bağlı göğüs ağrısı, sekizin de de (%80) PVH nedeniyle alt ekstremite ağrısı vardı. SKS işlemi öncesi ve sonrası görsel analog skala derecelerine (VAS) göre ağrı skorlarını, opioid kullanımı ve hastaların işlem memnuniyetini karşılaştırdık. Bulgular Olguların işlem öncesi ve sonrası ağrı skorları değerlendirildi. Tüm olguların SKS işlemi öncesi VAS 9.00 ± 0.81, işlemden sonra birinci ayda kaydedilen VAS 2.90 ± 0.99 olarak bulunmuştur. SKS sonrası hastaların tümünün ağrı şiddetinin belirgin olarak azaldığı görülmüştür. Bu azalma istatistiksel olarak anlamlı bulunmuştur (p<0.05). Sonuç Çalışmamızın sonuçlarına göre SKS’nin etkili ve güvenilir bir tedavi yöntemi olduğu görüşündeyiz. Tüm medikal ve cerrahi yöntemlerinin yetersiz kaldığı anjina pektoris ve PVH gibi şiddetli iskemik ağrıya sebep olan durumlarda, SKS işlemi bir tedavi seçeneği olarak düşünülmelidir. SKS, kronik ciddi iskemik ağrıda etkili ve başarılı bir tedavi yöntemidir.

Anahtar Kelimeler

• Kronik ağrı
• Spinal kord stimülasyonu
• İskemik ağrı

Spinal Cord Stimulation in Ischemic Pain: A Case Series

Abstract

ABSTRACT Objective Neuromodulation has a significant place among the interventional methods, in the treatment of chronic pain. Spinal Cord Stimulation (SCS) is the most applied treatment method among neuromodulation methods. SCS procedure is a neuromodulation method used for ischemic pain, failed back surgery syndrome, neuropathic pain, and cancer pain. In our study, the effects of SCS on pain intensity were investigated in patients diagnosed with ischemic chronic pain in the lower extremity due to peripheral vascular disease (PVD). Material and Methods The ten patients who were applied SCS were included in the retrospective study conducted between April 2020-April 2024 in the University Algology Department. Two (20%) of the patients had chest pain due to chronic angina pectoris, and 8 (80%) had lower extremity pain due to PVH. We compared pain scores in line with visual analog scale degrees (VAS) before and after the SCS procedure, opioid use and compared the patient satisfaction with the procedure. Results Pain scores of the patients before and after the procedure were evaluated. The VAS of all cases before the SCS procedure was 9.00 ± 0.81, and the VAS recorded in the 1st month after the procedure was 2.90 ± 0.99. It was observed that the pain intensity of all patients decreased significantly after SCS. This decrease was found to be statistically significant (p<0.05). Conclusion According to the results of our study, we are of the opinion that SCS is an effective and safe treatment method. In cases where all medical and surgical methods are insufficient and cause severe ischemic pain, such as angina pectoris and PVH, the SCS procedure should be considered as a treatment option. SCS is an effective and successful treatment method for chronic severe ischemic pain.

Keywords

• Chronic pain
• Spinal cord stimulation
• Ischemic pain

References

1. 1.Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Leong M, Makey S, North R, Neuromodulation Appropriateness Consensus Committee. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus committee. Neuromodulation. 2014; 17(6): 515-50.
2. 2. Van Kleef M, Staats P, Mekhail N, Huygen F. Chronic refractory angina pectoris. Pain Pract. 2011;11(5):476-82.
3. 3. Eliasson T, Augustinsson LE, Mannheimer C. Spinal Cord Stimulation in severe angina pectoris—presentation of current studies, indications and clinical experience. Pain 1996; 65:169-179.
4. 4. Deer TR, Raso LJ. Spinal cord stimulation for refractory angina pectoris and peripheral vascular disease. Pain Physician. 2006;9(4):347-52.
5. 5. Akbaş M, Dinç B. Ağrı tedavisinde nöromodülasyon. Türkiye Klinikleri. 2018; 4-12.
6. 6. Song JJ, Popescu A, Bell RL. Present and Potential Use of Spinal Cord Stimulation to Control Chronic Pain. Pain Physician. 2014;17(3): 235-46.
7. 7. Eldabe S, Thomson S, Duarte R, Brookes M, deBelder M, Raphael J, Davies E, Taylor R. The effectiveness and Cost-Effectiveness of Spinal Cord Stimulation for Refractory Angina (RASCAL Study): A Pilot Randomized Controlled Trial. Neuromodulation. 2016; 19(1): 60-70.
8. 8. Wu M, Linderoth B, Foreman RD. Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: A review of experimental studies. Auton Neurosci 2008, 138:9-23.

9. 9. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: A randomized, controlled trial. Pain 2007; 132(1-2): 179-188.
10. 10. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O'Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. Spinal cord stimulation versus conventional medical management for neuropathic pain: A multicentre randomized controlled trial in patients with failed back surgery syndrome. Pain 2007; 132(1-2): 179-188.
11. 11. Kumar K, North R, Taylor R, Sculpher M, Van den Abeele C, Gehring M, Thomson S, Tracey S, Reny P, Banks C, Leruth S, Kelly C, Jacobs M. Spinal cord stimulation vs. conventional medical management: a prospective, randomized, controlled, multicenter study of patients with failed back surgery syndrome (PROCESS study). Neuromodulation. 2005; 8: 213–8.
12. 12. Ubbink DT, Vermeulen H. Spinal cord stimulation for critical leg ischemia: a review of effectiveness and optimal patient selection. J Pain Symptom Manage. 2006; 31(4 Suppl): S30-5.
13. 13. Taylor RS, Desai MJ, Rigoard P, Taylor RJ. Predictors of Pain Relief Following Spinal Cord Stimulation in Chronic Back and Leg Pain and Failed Back Surgery Syndrome: A Systematic Review and Meta-Regression Analysis. Pain Practice 2014; 14(6):489–505.
14. 14. Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O'Callaghan J, Eisenberg E, Milbouw G, Buchser E, Fortini G, Richardson J, North RB. The effects of spinal cord stimulation in neuropathic pain are sustained: A 24-month follow-up of the prospective randomized controlled multicenter trial of the eff ectiveness of spinal cord stimulation. Neurosurgery 2008; 63(4): 762-770.
15. 15. Linderoth B, Foreman RD. Physiology of spinal cord stimulation: review and update. Neuromodulation. 1999; 2(3): 150-64.
16. 16. Hurley RW, Adams MC, Benzon HT. Neuropathic pain: treatment guidelines and updates. Current Opinion in Anesthesiology. 2013; 26(5): 580-7.
17. 17. Eliasson T, Augustinsson LE, Mannheimer C. Spinal cord stimulation in severe angina pectoris-presentation of current studies, indications and clinical experience. Pain. 1996; 65(2-3): 169-79.
18. 18. Kemler MA, Furnée CA. Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy. Neurology. 2002; 59(8): 1203-9.
19. 19. Ohnmeiss DD, Rashbaum RF, Boddanffy GM. Prospective evaluation of spinal cord stimulation in patients with intractable leg pain. Spine 1996; 21:1344–51.
20. 20. North RB, Kidd DH, Zahurak M, et al. Spinal cord stimulation for chronic, intractable pain: experience over two decades. Neurosurgery 1993; 32: 384-94.
21. 21. Sanders RA, Moeschler SM, Gazelka HM, Lamer TJ, Wang Z, Qu W, Hoelzer BC. Patient Outcomes and Spinal Cord Stimulation: A Retrospective Case Series Evaluating Patient Satisfaction, Pain Scores, and Opioid Requirements. Pain Pract. 2016; 16(7):899-904.
22. 22. Akbaş M, Yegin A, Yılmaz H, Altekin RE, Sabit MJ, Sanlı S. Unstable angına pectoris and spinal cord stimularion. Anesth Pain Intensive Care 2015;19(3):383-85.
23. 23. Ubbink DT, Vermeulen H. Spinal cord stimulation for critical leg ischemia: a review of effectiveness and optimal patient selection. J Pain Symptom Manage. 2006; 31(4 Suppl): S30-5.
24. 24. Ekre O, Eliasson T, Norrsell H, Währborg P, Mannheimer C. Electrical Stimulation versus Coronary Artery Bypass Surgery in Severe Angina Pectoris. Long-term effects of spinal cord stimulation and coronary artery bypass grafting on quality of life and survival in the ESBY study. Eur Heart J. 2002, 23(24):1938-45.
25. 25. De Vries J, Foreman RD, DeJongste MJ. The anti-ischemic effects of electrical neurostimulation in the heart. Cleve Clin J Med. 2007; 74(Suppl 1): S42-7.
26. 26. Wu M, Linderoth B, Foreman RD. Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: A review of experimental studies. Auton Neurosci. 2008, 138:9-23.
27. 27. Mannheimer C, Eliasson T, Andersson B, Bergh CH, Augustinsson LE, Emanuelsson H, Waagstein F. Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action. BMJ 1993; 307:477- 480.
28. 28. Hautvast RW, DeJongste MJ, Horst FJ, Blanksma PK, Lie KI. Angina pectoris refractory for conventional therapy-is neurostimulation a possible alternative treatment? Clin Cardiol 1996; 19:531-5.
29. 29. Mobilia G, Zuin G, Zanco P, Di Pede F, Pinato G, Neri G, et al. Effects of spinal cord stimulation on regional myocardial blood flow in patients with refractory angina. A positron emission tomography study. G Ital Cardiol. 1998; 28:1113-9.
30. 30. Ramineni, P, Patel, L, Haller, F, Argoff, P. The Impact of Spinal Cord Stimulation on Sleep Patterns. Neuromodulation. 2016; 19(5):477-81.
31. 31. Obuchi M, Sumitani M, Shin M, Ishii K, Kogure T, Miyauchi S, Yamada Y. Spinal cord stimulation ameliorates neuropathic pain-related sleep disorders: a case series. Neuromodulation. 2015; 18(3): 191-3.
32. 32. Costantini A. Spinal cord stimulation. Minerva anestesiologica. 2005; 71(78): 471-4.
33. 33. Turner JA, Loeser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain. 2004; 108(1-2): 137-47.
34. 34. Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. Journal of Neurosurgery. 2004; 100(3 Suppl Spine): 254-67.
35. 35. Meglio M, Cioni B, Rossi GF. Spinal cord stimulation in management of chronic pain. A 9-year experience. J Neurosurg. 1989; 70(4): 519-24.