22nd Annual Pain Medicine Meeting 2023

Single lead cervical spinal cord stimulation in management of refractory postherpetic neuralgia

Shayla Mena M.D., Jijun Xu M.D. Ph.D., Christina Shin M.D.
Department of Pain Management, Cleveland Clinic Foundation, Cleveland, OH

Department Chair: Richard Rosenquist, M.D.

Case Description

The Patient

o82-year-old legally blind female with PMH SSS s/p PPM

oHistory of shingles complicated by postherpetic neuralgia

oPresented to pain management clinic with severe debilitating pain in the right neck, shoulder, and arm

•Dermatomes: right C4 - C6, and T1

•Pain Quality: "hot poker" and "electric-shock”

•Prior treatments: topical creams and ointments, oral steroids, neuropathic agents, opioids, acupuncture, and cervical epidural steroid injections

The Intervention

oRight sided, percutaneous octapolar Medtronic dorsal column spinal cord stimulator lead to C4

oTrial resulted in >90% relief with improvement in function

oPermanent SCS implantation (Medtronic VantaTM)

The Outcome

oTwo weeks following permanent implantation:

•>90-100% relief with 0/10 pain on most days

•No adverse effects

•Occasional, non-painful paresthesias (“Tingling”)

oImproved function and quality of life

•Attend more social activities

•Able to brush teeth and hair

oSustained relief and functional improvement at 5 month follow up

Discussion

oReview of PHN patients treated with neuromodulation:

•Large numbers of patients treated with traditional SCS (i.e., infrequent dorsal root ganglion stimulation, burst SCS, and high-frequency SCS)[1]

•Long-term pain relief (67.9%), mean follow up of 12.85 months

•PHN head and facial pain treated via placement of leads in cervical spine or cervicomedullary junction[2]

•Satisfactory pain relief for a mean of 4.6 versus 4.2 years

oBenefit of spinal neuromodulation: lack of an external device

oVisually impaired patients can be ideal candidates

oUse of a non-rechargeable implantable pulse generator

References

[1] Isagulyan E, Tkachenko V, Semenov D, et al. The Effectiveness of Various Types of Electrical Stimulation of the Spinal Cord for Chronic Pain in Patients with Postherpetic Neuralgia: A Literature Review. Pain Res Manag. 2023;2023:6015680.

[2] Chivukula S, Tempel ZJ, Weiner GM, et al. Cervical and cervicomedullary spinal cord stimulation for chronic pain: efficacy and outcomes. Clin Neurol Neurosurg. 2014 Dec;127:33-41.

22nd Annual Pain Medicine Meeting 2023

SINGLE LEAD CERVICAL SPINAL CORD STIMULATION IN MANAGEMENT OF REFRACTORY POSTHERPETIC NEURALGIA

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