Can A Spinal Cord Stimulator Be Removed
Korean J Pain. 2022 Jan; 32(ane): 47–l.
Successful removal of permanent spinal cord stimulators in patients with complex regional pain syndrome afterwards complete relief of hurting
Su Jung Lee
1Section of Anesthesia and Hurting Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
Yeong Min Yoo
1Department of Anesthesia and Hurting Medicine, Schoolhouse of Medicine, Pusan National University, Yangsan, Korea.
Jun A You
aneSection of Anesthesia and Hurting Medicine, Schoolhouse of Medicine, Pusan National Academy, Yangsan, Korea.
Sang Wook Shin
iDepartment of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea.
Tae Kyun Kim
1Section of Anesthesia and Pain Medicine, School of Medicine, Pusan National Academy, Yangsan, Korea.
Salahadin Abdi
twoSection of Pain Medicine, Division of Anesthesia and Critical Care, The University of Texas Doc Anderson Cancer Center, Houston, TX, Usa.
Kyung Hoon Kim
1Section of Anesthesia and Pain Medicine, School of Medicine, Pusan National Academy, Yangsan, Korea.
Received 2022 Nov 22; Revised 2022 December xi; Accepted 2022 December 11.
Abstract
Groundwork
It is uncommon for patients who accept received a permanent implant to remove the spinal cord stimulator (SCS) after discontinuation of medication in complex regional pain syndrome (CRPS) due to their completely painless country. This study evaluated CRPS patients who successfully removed their SCSs.
Methods
This 10-year retrospective study was performed on patients who had received the permanent implantation of an SCS and had removed it 6 months after discontinuation of stimulation, while halting all medications for neuropathic hurting. Age, sex, duration of implantation, site and type of CRPS, and their return to work were compared between the removal and non-removal groups.
Results
Five (12.5%, M/F = 4/1) of 40 patients (Thousand/F = 33/7) successfully removed the permanent implant. The hateful age was younger in the removal grouping (27.2 ± half dozen.4 vs. 43.5 ± 10.7 years, P < 0.01). The hateful elapsing of implantation in the removal grouping was 34.4 ± 18.2 months. Ii of 15 patients (thirteen.iii%) and 3 of 25 patients (12%) who had upper and lower extremity pain, respectively, had removed the implant. The implants could exist removed in 5 of 27 patients (eighteen.five%) with CRPS type 1 (P < 0.01). All five patients (100%) who removed their SCS returned to work, while simply 5 of 35 (14.three%) in the non-removal group did (P < 0.01).
Conclusions
Fifty-fifty though this study had limited data, younger patients with CRPS blazon 1 could remove their SCSs within a v-twelvemonth period and return to work with complete pain relief.
Keywords: Age factors, Complex regional hurting syndrome, Device removal, Extremities, Humans, Neuropathic pain, Retrospective studies, Render to work, Spinal cord stimulation
INTRODUCTION
Traditionally, circuitous regional pain syndrome has been treated with medication, using an anticonvulsant and an antidepressant with a weak opioid for neuropathic hurting, thoracic or lumbar sympathectomy for cold allodynia, and a spinal string stimulator (SCS), if these treatments have failed.
All the same, it is uncommon to observe full recovery from the pain of CRPS. Total recovery from the pain of CRPS in this report was defined as a painless country after the removal of the SCS even after reduction and final cessation of all medication and consummate cessation of the SCS for at least half dozen months.
Use of an SCS for the treatment of CRPS was considered a last resort therapy because of its high price and level of invasiveness. Yet, information technology is at present considered earlier (at around 3 months), as soon equally more conservative therapies have failed [1].
This study evaluated patients who successfully removed the SCS in CRPS cases retrospectively co-ordinate to age, sexual practice, type of CRPS, involved extremity, duration betwixt an initiating baneful event to implantation, and duration of implantation of the SCS.
MATERIALS AND METHODS
1. Study design, setting, and participants
A review of the charts of all patients who underwent implantation during a x-yr menses, from 2003 to 2022, was performed on CRPS patients who had received the permanent implantation of an SCS and had removed it 6 months after discontinuation of stimulation, while halting all medications for neuropathic hurting (IRB 05-2018-048).
The CRPS was diagnosed by the Budapest clinical diagnostic criteria and a positive typical (increment of the uptake in all of blood flow, blood pool, and delayed phases in the early on phase of CRPS) and singular (increased uptake but on the delayed phase with normal or decreased uptake on the flow and blood pool phases in the tardily phase of CRPS or in young CRPS patients with paralysis and immobilization, respectively) patterns of in 3-phase bone scans [2,3].
The exclusion criterion was patients with less than a 6-month discontinuation of stimulation after halting all medications for neuropathic hurting.
ii. Variables
Patients were divided into removal and non-removal groups. Age at the fourth dimension of implantation (year), sex (M/F), site and blazon of CRPS (1 or 2), and their returning to work (yes or no) were compared between the removal and non-removal groups. Durations (months) between an initiating baneful event to implantation and elapsing of implantation (months) between the removal and non-removal groups were likewise evaluated.
iii. Statistical methods
Demographic data included age and sex distribution of the total number and the number of each grouping in the removal and not-removal group who had received a permanent SCS. The hateful age in both groups was compared, using an contained t-test. The g ender ratio in both groups was compared using the chi-squared test.
The site and blazon of CRPS, and their returning to piece of work (yes or no), were calculated as a percentile from each group, and compared both groups analyzed with the chi-squared exam.
The mean durations (months) of between an initiating effect and implantation were compared between the removal and non-removal groups.
The hateful duration of implantation (months) in the removal group were calculated.
A P value less than 0.05 was considered statistically significant. The statistical analyses were performed using SPSS 23 (IBM Corporation, Armonk, New York).
RESULTS
Five (12.v%, Chiliad/F = 4/1) amongst the 40 patients (M/F = 33/7) successfully removed the permanent implant. The hateful age was younger in the removal group than the non-removal group (27.2 ± 6.4 vs. 43.5 ± 10.7 years, P < 0.01) (Table 1). Two of 15 patients (thirteen. 3%) who had upper extremity hurting and 3 of 25 patients (12%) who had lower extremity pain had removed the implant.
Table one
Comparison of Data between the Removal and Non-removal Groups
The hateful durations between an initiating issue and implantation in the removal and non-removal groups were 39.0 ± 22.3 months, ranging from 8 to 64 months versus 39.0 ± 30.0 months, ranging from 7 to 120 months.
The mean duration of implantation in the removal group was 34.4 ± xviii.2 months, ranging from 17 to 59 months. On the other hand, the mean duration of implantation in the non-removal group was 38.9 ± 31.2 months, ranging from seven to 127 months.
The permanent implants could only exist removed in patients with CRPS type 1 [in 5 of 27 (18.five%) vs. 0 of 13 patients with CRPS type ane and 2, respectively, P < 0.01] (Table 1).
All five patients (100%) that removed the SCS returned to work; only v of 35 patients (fourteen.3%), who did not remove it returned to work (P < 0.01) (Tabular array 1).
DISCUSSION
Even though this report had a limited number of information, relatively young patients with CRPS type 1 had a better prognosis for complete pain relief afterwards SCS implantation, and could remove the SCS within a 5-twelvemonth menstruation (17–59 months) and return to their piece of work.
SCS has been shown to reduce pain and ameliorate quality of life within both a 6-month and 2-twelvemonth menstruum [4,5]. Still, it is difficult for patients who have implanted a permanent SCS to obtain long-term hurting coverage for longer than 5 years, fifty-fifty with a successful trial after psychologic cess [6]. Afterwards a gradual reduction and concluding cessation of medications, the cases where there are no further hurting complaints are extremely rare, even after abeyance of SCS for 6 months.
Known poor outcome predictors for successful SCS implantation are express, but include smoking [vii], highdose opioid usage [8], psychological factors, such equally somatization, depression, anxiety, poor coping, older age, a longer hurting duration [9], an implanter with trivial experience, and wrong etiologies of patient pain [10].
Pain characteristics for a good candidate for an SCS are steady, called-for, lancinating chronic neuropathic pain, non tedious, aching nociceptive pain [eleven]. In addition, in our dispensary, patients with CRPS, a benign musculoskeletal sympathetic-maintained pain, could take an anticonvulsant and antidepressant with only weak opioids (tramadol and codeine), without using strong opioids.
In this study, merely relatively young patients in their twenties, with the exception of 1 patient anile 39, had a successful removal of the permanent SCS. Young patients may accept greater flexibility returning from the disturbance of the sympathetic nervous system [12].
5 of 27 (xviii.5%) patients with CRPS blazon 1 had a successful removal; however, none of 13 patients with CRPS type 2 qualified for removal. CRPS type 1, without nerve injury on the electromyogram/nerve conduction test, had a meliorate prognosis.
In addition, all five patients (four students and 1 sailor) continued their piece of work afterward a brief period of hospitalization during the implantation period. On the contrary, just 5 of 35 patients, who failed to remove the SCS, had jobs.
It was difficult to find the deviation for the prognosis betwixt upper (2/15, 13.3%) and lower (3/25, 12%) extremities. There was n o bear witness o f difference b etween male (4/33, 10%) and female (1/7, 14.iii%) patients. Durations (calendar month) between an initiating noxious event to implantation were variable in the removal group; 8, 25, 48, fifty and 64 months. We could not find the difference of durations between the removal and non-removal group.
There are 3 kinds of insurance coverage in Korea: national wellness, automobile, and workers' accident compensation insurance. Patients with the latter ii types of insurance do non have to pay their costs. Iv of 24 (xvi.7%) and one of 12 (8.3%) patients had a successful removal of their SCSs in the health and industrial blow insurance groups, respectively. Withal, the differences among types of insurance were not articulate because this study had but a express number of patients.
In Korea, the 3 major health insurance systems crave at least these 3 criteria for SCS implantation; 1) the Budapest clinical diagnostic criteria for CRPS, 2) consultation with a psychologist for the evaluation of depression, bounty, or secondary gain, and iii) a medication history for neuropathic pain with maximal dosage of an anticonvulsant and antidepressant for at to the lowest degree 6 months. All implantation cases were fulfilled these criteria.
In our experience, long-term utilise of stiff opioids (peculiarly, the firsthand release type) may hinder discontinuation of all medications and achieving a successful removal of SCSs.
The limitations of this study are the express data of one hospital and an insufficient duration. Even so, this study proves a expert event in young patients with CRPS type 1.
In determination, only immature patients with CRPS type 1 could remove a permanent SCS within five years and render to work with consummate relief of hurting, regardless of sex, site of CRPS, hateful duration of an initiating event to implantation, mean duration of implantation, and blazon of insurance in this report.
Footnotes
The authors declare that there is no conflicts of involvement and no source of funding.
References
1. Poree L, Krames E, Pope J, Deer TR, Levy R, Schultz Fifty. Spinal cord stimulation as treatment for complex regional pain syndrome should be considered earlier than last resort therapy. Neuromodulation. 2013;sixteen:125–141. [PubMed] [Google Scholar]
2. Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Circuitous Regional Pain Syndrome. Pain. 2010;150:268–274. [PMC free article] [PubMed] [Google Scholar]
4. Kemler MA, Barendse GA, van Kleef K, de Vet HC, Rijks CP, Furnée CA, et al. S pinal cord stimulation i n patients west ith chronic reflex sympathetic dystrophy. Due north Engl J Med. 2000;343:618–624. [PubMed] [Google Scholar]
v. Kemler MA, De Vet HC, Barendse GA, Van Den Wildenberg FA, Van Kleef G. The effect o f spinal c ord stimulation i n patients with chronic reflex sympathetic dystrophy: two years' follow-upwards of the randomized controlled trial. Ann Neurol. 2004;55:13–18. [PubMed] [Google Scholar]
6. Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA, van Kleef G. Effect of spinal cord stimulation for chronic circuitous regional hurting syndrome Blazon I: five-twelvemonth concluding follow-up of patients in a randomized controlled trial. J Neurosurg. 2008;108:292–298. [PubMed] [Google Scholar]
7. De La Cruz P, Fama C, Roth S, Haller J, Wilock M, Lange South, et al. Pred ictors o f spinal c ord stimulation success. Neuromodulation. 2015;18:599–602. [PMC costless article] [PubMed] [Google Scholar]
8. Sharan AD, Riley J, Falowski S, Pope JE, Connolly AT, Karst E, et al. Association of opioid usage with spinal cord stimulation outcomes. Pain Med. 2018;19:699–707. [PubMed] [Google Scholar]
ix. Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Hurting Med. 2009;10:639–653. [PubMed] [Google Scholar]
ten. Verrills P, Sinclair C, Barnard A. A review of spinal cord stimulation systems for chronic hurting. J Pain Res. 2016;nine:481–492. [PMC free article] [PubMed] [Google Scholar]
11. Deer T, Masone RJ. Selection of spinal cord stimulation candidates for the treatment of chronic pain. Pain Med. 2008;9:S82–S92. [Google Scholar]
12. Hoehn-Saric R, McLeod DR. The peripheral sympathetic nervous system. Its role in normal and pathologic anxiety. Psychiatr Clin Northward Am. 1988;11:375–386. [PubMed] [Google Scholar]
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Can A Spinal Cord Stimulator Be Removed,
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333578/
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