Utilization of Proprietary Paresthesia Free Spinal Cord Stimulation for Post-Mastectomy Pain Syndrome

Morgan Cowan DO, Vishal Bansal MD, Colton Besett MD, Edward Pingenot DO, Brian Bruel MD

INTRO

• Approximately 1.7 million new cases of breast cancer are diagnosed every year in women worldwide. Of these, an estimated 25 to 50 percent of women who undergo breast cancer related surgery will suffer from post-mastectomy pain syndrome (PMPS).

• The pathophysiology of this pain syndrome appears to be due to unresolved inflammation, sensitization of peripheral nociceptive fibers, neuroma formation, and/or sensitization of neurons within the central nervous system.

• While scientific literature concerning PMPS has been available for more than 40 years, the standard of care for the treatment of PMPS has yet to be established.

• We describe a case in which a patient with intractable neuropathic cancer-related pain achieved symptom relief and improved quality of life with proprietary paresthesia free, targeted spinal cord stimulation (SCS).

DISCUSSION

• In short,increasedfiringofWDRneuronsdueto excitatory components of the neural pathways regulating pain signals results in increased signaling to the brain. Targeting of surrounding inhibitory neurons helps to mitigate this process.

• Historically,sub-paresthesiaspinalcordstimulation had a long “wash-in” period and thus made programming and identifying appropriate capture and dosing for stimulation difficult. A typical programming “session” could take days for the patient to begin feeling the relief from the sub- paresthesia stimulation.

• In this patient, paresthesia-based programming and mapping in the office were utilized which, once appropriate capture is achieved, is then modified to below the patient’s paresthesia threshold. This results in patients achieving pain relief within minutes of programming.

• Toourknowledge,thisisthefirstreportedcaseof this novel SCS technology being utilized for the treatment of PMPS.