Spinal Cord and Peripheral Nerve Stimulation Techniques for Neuropathic Pain in Cancer
Oscar A. de Leon-Casasola, M.D.
Professor of Anesthesiology and Medicine
Vice-Chair for Clinical Affairs, Department of Anesthesiology
State University of New York at Buffalo - School of Medicine and Biomedical Sciences
Chief, Pain Medicine and Professor of Oncology
Department of Anesthesiology and Pain Medicine
Roswell Park Cancer Institute
Buffalo, New York
Introduction
- TOP
When comprehensive medical pharmacological therapy titrated to maximum doses fails to provide an appropriate level of analgesia, or side effects associated with these therapies impair the ability to increase the doses to obtain appropriate therapeutic effects in patients with a variety of chronic neuropathic pain conditions, alternative methods such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS), are effective alternative options. These technologies use high-frequency, low-stimulation currents that are delivered via electrodes that are either percutaneously implanted in close proximity to peripheral nerves (PNS) or implanted in the epidural space of the spine to stimulate either the nerve roots or the dorsal columns as they exit the spinal canal (SCS). These electrodes are then connected subcutaneously to an implanted generator unit.1
SCS has been utilized to relieve pain since 1967 when Shealy and colleagues pioneered the technology for a patient with metastatic cancer.2 Although the technique is employed today most commonly to relieve chronic pain associated with failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), ischemic limb pain, and angina pectoris, it has also been implemented to address other intractable neuropathic and chronic visceral pain conditions. In the majority of cases, SCS or PNS is used as a component of a multimodal therapeutic plan designed to control a patient’s pain while decreasing the doses of analgesics, and in rare cases, pain medications are discontinued completely.
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