Significant pain reduction in refractory post-mastectomy pain syndrome with closed-loop spinal cord stimulation: illustrative cases.

Brooke Elberson, Lauren Banko, Jonathan Bauer, Erika Petersen, Gregory Lawson Smith
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Abstract

Background: Breast cancer is one of the most common malignancies worldwide and is often treated with surgery. Post-mastectomy pain syndrome (PMPS) can have disabling consequences. The incidence of PMPS ranges from 20% to 68%. Undertreated PMPS results in 10% of opioid-naive patients continuing to use opioids 90 day after surgery. Management has been centered around medications, psychological support, and peripheral nerve blocks. Case reports and series have been published describing dorsal root ganglion stimulation and spinal cord stimulation (SCS), but overall literature is lacking for this complex problem and no studies used closed-loop SCS.

Observations: Two patients experienced ≥ 80% relief of pain with SCS for refractory post-mastectomy pain. In both cases, percutaneous cylindrical leads were positioned over the cervicothoracic junction and utilized an evoked compound action potential-controlled closed-loop pulse generator (Evoke).

Lessons: Closed-loop SCS is an effective option for refractory PMPS and should be considered when conservative options fail. https://thejns.org/doi/10.3171/CASE25218.

Abstract Image

Abstract Image

采用闭环脊髓刺激治疗难治性乳房切除术后疼痛综合征的显著疼痛减轻:说明性病例。
背景:乳腺癌是世界范围内最常见的恶性肿瘤之一,通常采用手术治疗。乳房切除术后疼痛综合征(PMPS)可能会导致残疾。经前症候群的发病率从20%到68%不等。治疗不足导致10%的阿片类药物新手患者在手术后90天继续使用阿片类药物。治疗以药物治疗、心理支持和周围神经阻滞为主。已经发表了关于背根神经节刺激和脊髓刺激(SCS)的病例报告和系列报道,但缺乏针对这一复杂问题的整体文献,也没有使用闭环SCS的研究。观察:有2例患者接受SCS治疗后乳房切除术后难治性疼痛缓解≥80%。在这两种情况下,经皮圆柱形导线放置在颈胸交界处,并使用诱发复合动作电位控制闭环脉冲发生器(Evoke)。经验教训:闭环SCS是难治性PMPS的有效选择,当保守选择失败时应考虑。https://thejns.org/doi/10.3171/CASE25218。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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