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  4. Burst spinal cord stimulation for central neuropathic pain Two case reports

Burst spinal cord stimulation for central neuropathic pain Two case reports

Medicine, 2021 · DOI: http://dx.doi.org/10.1097/MD.0000000000024628 · Published: February 1, 2021

NeurologyPain Management

Simple Explanation

Central neuropathic pain is difficult to treat because it originates from injuries to the central nervous system. Traditional treatments don't always work well. Burst spinal cord stimulation is a newer type of treatment that may be more effective for some people with this type of pain. It involves sending electrical pulses to the spinal cord. This paper discusses two cases where burst spinal cord stimulation was used to treat patients with central neuropathic pain caused by spinal cord injury or traumatic brain injury, showing promising results.

Study Duration
Not specified
Participants
2 patients: one with SCI, one with traumatic brain injury
Evidence Level
Level 4: Two case reports

Key Findings

  • 1
    Burst SCS was effective in reducing pain intensity and frequency in a patient with neuropathic pain following spinal cord injury.
  • 2
    Alternating between tonic and burst stimulation provided initial pain relief for a patient with neuropathic pain from traumatic brain injury, although the pain relief diminished over time before improving again with the alternating approach.
  • 3
    The study suggests that burst SCS can be a valuable option for central neuropathic pain management due to the severity and refractory nature of the pain, along with the limited alternative therapies available.

Research Summary

This paper presents two case reports where burst spinal cord stimulation (b-SCS) was used to treat patients with central neuropathic pain resulting from spinal cord injury (SCI) or traumatic brain injury. The first case involved a patient with SCI who experienced reduced pain intensity and frequency after b-SCS implementation. The second case involved a patient with traumatic brain injury who initially benefited from alternating tonic and burst stimulation, although the pain relief diminished over time before improving again with the alternating approach. The authors conclude that b-SCS shows promise in managing central neuropathic pain, considering the limited treatment options and the refractory nature of the pain associated with central nervous system injuries.

Practical Implications

Clinical Practice

Burst SCS can be considered as a potential treatment option for patients with central neuropathic pain, especially those with pain refractory to other treatments.

Future Research

Further prospective, controlled studies with larger patient populations are needed to confirm the efficacy of burst SCS and identify the patient populations most likely to benefit from this therapy.

Personalized Treatment

Alternating between tonic and burst waveforms may optimize pain control effects in certain patients.

Study Limitations

  • 1
    Small sample size (two case reports)
  • 2
    Lack of a control group
  • 3
    Mechanism of b-SCS not fully understood

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