The treatment of chronic pain by epidural spinal cord stimulation--a 15 year follow up; present status.

Abstract

Pain is necessary for survival but chronic pain is disabling and causes significant health and economic problems. This study provides an understanding of the future for spinal cord stimulation. Stimulation by means of chronically implanted electrodes, was carried out in 200 patients with pain of varied benign organic etiology. In 177 of them, pain was confined to the failed back syndrome. Most patients were referred by a Pain Management Service. 226 epidural implants were used: 80 unipolar, 59 Resume, 12 bipolar, and 75 quadripolar. Patients were followed for periods of 6 months to 12 years, with a mean follow-up of 44 months. 84 patients (42%) were able to control their pain by stimulation alone, 22 patients (11%) needed occasional analgesic supplements along with their stimulation program. Pain secondary to failed back syndrome, multiple sclerosis, peripheral vascular disease, sympathetic dystrophy and diabetic neuropathy responded favorably. Pain due to cauda equina injury, paraplegic pain and phantom limb pain responded poorly. Complications included wound infection, displaced or fracture electrode, and fibrosis at the stimulating tip. Spinal cord stimulation has proven to be effective in the treatment of chronic benign pain.