Case SeriesThe Use of 10-Kilohertz Spinal Cord Stimulation in a Cohort of Patients With Chronic Neuropathic Limb Pain Refractory to Medical Management
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INTRODUCTION
Chronic neuropathic pain syndromes result from peripheral or central nerve lesions or neural dysfunction due either to traumatic events (e.g., amputation, spinal cord injury) or to systemic disease (e.g., diabetes, viral infection, and cancer) (1).
Established pharmacological treatments for neuropathic pain achieve effective pain relief in only one-third of treated patients, and adverse events are frequent (2). This neuropathic pain is often associated with a significant disruption of quality of
METHODS
We retrospectively reviewed the medical records of all patients who underwent a trial with high-frequency 10-kHz SCS for neuropathic pain. Under United Kingdom guidelines, this study, as an anonymous audit of outcomes, did not require ethics committee approval (14).
RESULTS
Fifteen patients with chronic neuropathic pain completed a trial of high-frequency 10-kHz SCS. Demographic data are presented in Table 1. Thirteen of 15 patients had a baseline painDETECT score of greater than 19 (mean 28.9 ± 8.4), indicating a strong neuropathic component to their chronic pain complaint. Nine of 15 patients were diagnosed with either upper limb neuropathic pain (N = 6) or hand CRPS (N = 3), while six patients had a diagnosis of postsurgery knee or foot neuropathic pain (N = 3)
DISCUSSION
This retrospective case series is the first of its kind to report the use of high-frequency 10-kHz SCS for the treatment of chronic neuropathic limb pain. To date, reports on the same technology have focused primarily on FBSS with or without leg pain. These initial studies show paresthesia-free pain relief with associated improvements in disability and sleep (12., 13., 24.). In our series, high-frequency 10-kHz SCS was effective in reducing neuropathic pain affecting the upper or lower limbs,
CONCLUSION
In our case series, high-frequency 10-kHz SCS was shown to be a paresthesia-free and effective option for the treatment of upper and lower limb neuropathic pain. We also believe that our small, retrospective chart review analysis must be corroborated by either prospective randomized controlled studies or large-scale multicenter observational studies in this population of patients with neuropathic pain before it can be concluded that high-frequency 10-kHz SCS is both safe and effective in this
Acknowledgements
Eric Bulogne from Nevro Corporation provided assistance in writing this manuscript. We received editorial support from Dr. Elliot Krames, who is a paid consultant of Nevro Corporation. The patients were all seen at the Pain Management and Neuromodulation Centre, Guy’s and St Thomas’ Hospital, London, UK.
Authorship Statements
All authors contributed to the design, data collection, recruitment, analysis, and writing of the manuscript. All authors have reviewed the final version and consented to publication.
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