Spinal Cord Stimulation Shows Good Long-Term Results for Visceral Abdominal Pain

Thomas R. Collins

February 09, 2010

February 9, 2010 (San Antonio, Texas) — Spinal cord stimulation (SCS) shows good long-term results in relieving visceral abdominal pain in patients with chronic pancreatitis, according to one of the first studies to track these patients over an extended period.

The findings were reported here at the American Academy of Pain Medicine 26th Annual Meeting by researchers from the Cleveland Clinic in Ohio.

In a retrospective look at 30 consecutively treated patients with pain related to chronic pancreatitis, Leonardo Kapural, MD, PhD, director of pain management clinical research and associate professor of anesthesiology at the Cleveland Clinic Lerner College of Medicine and Case Western University, and colleagues observed that 24 of the patients reported at least a 50% reduction in pain on completion of the trials, which ranged from 4 to 14 days (average, 9 days). SCS lead tips were positioned at T5 (n = 10), T6 (n = 10), or T4 (n = 4).

For the 20 patients who were followed for a year, pain scores remained low after SCS. Opioid use also fell dramatically, indicating a durability of response.

Researchers said it's an encouraging sign that SCS might provide good long-term results for patients with chronic pancreatitis pain; to date, doctors have found treatments over the long haul to be elusive.

"Given the dismal history of conventional treatment for chronic visceral pain, our results suggest that SCS may be a very useful therapeutic option," Dr. Kapural and colleagues report. They say that a prospective trial is warranted.

The study involved 20 women and 10 men, all diagnosed with chronic pancreatitis, with an average of 7.8 years of chronic visceral pain. The most frequent pain was epigastric, but patients also complained of lower-upper-quadrant, right-upper-quadrant, and left-lower-quadrant pain, describing it as aching, sharp, and stabbing.

Sixteen of the patients had some history of depression, 7 had a remote history of alcohol abuse, and 2 had a history of drug abuse (1 had a history of both drug and alcohol abuse).

Before the trial, the average visual analog scale pain score was 8. The average pain score dropped to 3.67 over the course of the trial (< .001).

Six patients did not respond to SCS and 1 was lost to follow-up. In 3 patients, the SCS system had to be removed because of infection or lead migration.

In the 20 patients followed for the year, the average pain score remained at 3.6 (< .001).

Among those patients, daily opioid use fell from a morphine-equivalent of about 125 mg at baseline to less than 50 mg after a year.

Dr. Kapural hopes SCS will have an impact on the lives of patients with abdominal pain, 2 million of whom, he said, have severe pain requiring the attention of a pain-management clinician.

"It's the most prevalent symptom in any [gastroenterology] clinic and it exhausts an enormous amount of healthcare money because there are multiple surgeries and tests. Sophisticated scanning is involved in trying to figure out where the pain is coming from," Dr. Kapural said in an interview with Medscape Neurology. "Despite that, [the origin of] some of that abdominal pain remains unknown, and it does have an impact on the patient's socioeconomic status."

Jeffrey Tiede, MD, from the Columbia Interventional Pain Center in Missouri, and moderator of the session, told Medscape Neurology that the results were encouraging and that the needs of these patients are great.

"The majority of treatments now are very poor for chronic pancreatitis or visceral hyperalgesia — people who have been through 10 or so abdominal operations," he said. "So this is just a new modality that has some scientific basis for it."

A transition to SCS for such patients in common clinical practice might take time, Dr. Tiede added. "We've known about it for quite a while, and it's a very difficult pain population [to manage]. . . . It's going to be a slow acceptance. . . . We have to see the patients, and we don't [receive] a lot of referrals from [gastroenterologists]. But that being said, it is a modality for kind of the worst of the worst patients."

This study did not receive commercial support. Dr. Kapural and Dr. Tiede have disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 26th Annual Meeting: Abstract 123. Presented February 5, 2010.


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