Targeting the Gut via the Spine: Spinal Cord Stimulation to Treat Chronic Idiopathic Gastroparesis

Nivetha Srinivasan, MD; Haijun Zhang, MD; Andrew Kaufman, MD

Rutgers New Jersey Medical School

 

Introduction

Gastroparesis is characterized by delayed gastric emptying and commonly presents with difficult-to-treat abdominal pain and nausea, significantly reducing quality of life (QoL) [1]. Symptoms are often attributed to underlying dysautonomia, which delays gastric motility. Spinal cord stimulation (SCS) can interrupt sympathetic pathways that transmit pain signals to the thalamus and cerebral cortex, where pain is processed [1]. SCS has demonstrated benefit in patients with chronic visceral pain and may improve gastric motility by autonomic modulation [1-5]. This case report presents the use of SCS to treat idiopathic gastroparesis with intractable nausea, epigastric pain, and food intolerance, highlighting its potential as a novel therapy.

Case Description

Our patient is a 21-year-old female with chronic gastroparesis, lower gastrointestinal dysmotility status post colostomy, postural orthostatic tachycardia syndrome, and demyelinating disease. She developed intractable nausea, epigastric pain, and severe food intolerance in 2015 following multiple viral illnesses and was diagnosed with idiopathic gastroparesis. She experienced significant weight loss and was hospitalized for superior mesenteric artery syndrome, requiring chronic total parental nutrition, which eventually caused liver failure. Nutritional support was then transitioned to GJ-tube.

In late 2017, the patient received a gastric stimulator with initial symptomatic relief, but required three replacements due to battery depletion or lead migration. Following COVID-19 infection in 2023, the gastric stimulator’s efficacy diminished, with only partial improvement in nausea but persistent abdominal pain. Oral intake remained intolerable, prompting referral to our pain clinic.

In July 2024, the patient underwent a celiac plexus block with substantial pain relief and the ability to tolerate oral intake without nausea or vomiting for the first time in over a year. This supported her candidacy for the SCS trial. In March 2025, high-frequency SCS trial leads were placed at T5, resulting in 85% improvement in pain, nausea, and food intolerance. In June 2025, she underwent permanent SCS implantation with leads at T5. Since implantation, she has reported significant, sustained improvements in oral intake, pain, and QoL.