Case Series
The Use of 10-Kilohertz Spinal Cord Stimulation in a Cohort of Patients With Chronic Neuropathic Limb Pain Refractory to Medical Management

https://doi.org/10.1111/ner.12237Get rights and content

Objective

It is the purpose of this study to document our experience with the use of a 10-kHz high-frequency spinal cord stimulation (SCS) device for the relief of neuropathic pain of the upper and lower limbs.

Materials and Methods

A retrospective chart review was performed of all patients treated with the 10-kHz high-frequency SCS system for neuropathic pain (upper or lower limb) refractory to conventional treatment. All patients underwent a trial with one or two eight-contact percutaneous leads using 50-Hz traditional stimulation. If ≥80% paresthesia coverage of the painful area with traditional SCS was obtained, high-frequency 10-kHz SCS was used. Patients who had a significant reduction in pain score (≥50%) at the end of the trial received a permanent implant and were then followed for up to six months. Outcome measures included a numeric rating scale for pain, the Brief Pain Inventory, health-related quality of life (EQ-5D), the Pain Catastrophizing Scale, and patient satisfaction.

Results

Fifteen patients completed a trial of high-frequency 10-kHz SCS. Eleven patients proceeded to permanent implantation. Ten of the 11 patients who proceeded to full implantation had significant reductions in all of the collected outcome variables at one, three, and six months.

Conclusions

In this small cohort of patients, high-frequency 10-kHz SCS reduced pain and improved quality of life. However, before we can conclude that high-frequency 10-kHz SCS for neuropathic pain of the upper and lower extremities is efficacious, a large-scale multicenter observational study should be performed to corroborate our small retrospective study.

Section snippets

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.

REFERENCES (28)

  • MooreRA et al.

    Gabapentin for chronic neuropathic pain and fibromyalgia in adults

    Cochrane Database Syst Rev

    (2011)
  • McCarbergB et al.

    Consequences of neuropathic pain: quality-of-life issues and associated costs

    Am J Manag Care

    (2006)
  • SimpsonEL et al.

    Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin: systematic review and economic evaluation

    Health Technol Assess

    (2009)
  • Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin

    (2008)
  • Cited by (0)

    For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/bw/submit.asp?ref=1094-7159&site=1

    View full text