An Overview of Spinal Cord Stimulation and Intrathecal Opioid Infusion Systems

Samyadev Datta, MD

Center for Pain Management
Hackensack, NJ

Based on the landmark gate control theory proposed by Ronald Melzack and Patrick D. Wall, spinal cord stimulation is increasingly being used to treat various chronic pain conditions. This technique should be performed by an experienced, well-trained pain physician only after less invasive modalities have failed to provide adequate outcomes. Good responses are predicated on appropriate patient selection and an understanding of which conditions are more likely to respond to spinal cord stimulation. Prior to trial initiation, patients should undergo psychological evaluation. The trial period, which can last anywhere from a few days to a few weeks, allows the patient and clinician to evaluate responses to treatment. If at the end of the trial period, significant improvements in pain control and functionality are observed, then a spinal cord stimulator may be permanently implanted. Similar principles can be used when considering spinal opioid infusion systems, which have been used to treat both cancer-related and chronic nonmalignant pain. For patients with chronic malignant pain, Dr. Datta suggests that the trial duration should be shorter (eg, 3 or 4 days) and outcomes should focus on pain relief and reduced side effects, whereas patients with chronic noncancer pain should undergo a longer trial period that specifically targets functional improvement.

References

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). 2009;34:1078-1093.
Frey ME, Manchikanti L, Benyamin RM, et al. Spinal cord stimulation for patients with failed back surgery syndrome: a systematic review. Pain Physician. 2009;12:379-397.
Patel VB, Manchikanti L, Singh V, et al. Systematic review of intrathecal infusion systems for long-term management of chronic non-cancer pain. Pain Physician. 2009;12:345-360.
Kumar K, Taylor R, Jacques L, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132:179-188.

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