Effect of Spinal Cord Stimulation for Patients with Post-Zoster Neuralgia on the Trunk: A Case Report

Abstract

Post-zoster neuralgia is an intractable pain by medical treatment. However, practice guidelines for invasive procedures of medically intractable post-zoster neuralgia are unclear, and it is not clear to apply to individual cases. In our study, the effect of spinal cord stimulation (SCS) for patients with post-zoster neuralgia was described in old patients with episodic pain with constant pain, which have been poorly controlled with oral and invasive treatments. We used an SCS device (Synergy2 IPG, model 7427; Medtronic Inc, Minneapolis, MN) equipped with an electrode (1×8 standard Lead model 977A290; Medtronic Inc, Minneapolis, MN). One lead was placed in the left lower margin of the T12 vertebral body (pulse width 60 ms, pulse rate 20 Hz, amplitude 2.5 V) and it covered on the distribution to left 10, 11, 12 thoracic dermatomes. VAS decreased to 3-4 after SCS compared with baseline VAS and was sustained by 3-4 for 1 week and by 3-4 at 1 month. After 6 months, the pain remained at 4-5. In morphine consumption, the baseline doses were 200 mg/day that significantly reduced to 120 mg/day and 90 mg/day after 1-month and 6-months post-procedure. The dose of gabapentin (1,800 mg/day) before treatment. The dose of gabapentin in the first month did not significantly decrease in taking gabapentin (1,200 mg/day ) compared with the baseline dose (1,200 mg/day). Consumption after 6 months was also significantly reduced by 900 mg/day.