Pain-induced autonomic dysreﬂexia secondary to spinal cord injury with signiﬁcant improvement after spinal cord stimulator implantation

Interventional Pain Medicine, 2023 · DOI: https://doi.org/10.1016/j.inpm.2023.100254 · Published: April 27, 2023

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Spinal cord stimulation (SCS) is a treatment option for various conditions, including spinal cord injury (SCI). This report presents a unique case where SCS was used to manage recurrent episodes of autonomic dysreﬂexia (AD) in a SCI patient. AD is a condition characterized by a sudden increase in blood pressure in response to a stimulus below the level of spinal cord injury. In this case, the AD episodes were triggered by neuropathic and nociceptive pain. The patient underwent SCS implantation to address the pain and, consequently, reduce the frequency of AD episodes. The treatment proved successful in improving the patient's quality of life and reducing the need for opioid medications.

Study Duration

Not specified

Participants

1 female patient with chronic incomplete traumatic quadriplegia

Evidence Level

Case Report

Key Findings

1
The patient experienced a significant reduction in AD episodes following SCS implantation, with a reported 75% improvement in AD symptoms three months after the procedure.
2
The patient's reliance on opioid pain medications decreased substantially after SCS implantation, indicating a successful alternative for pain management.
3
Identification of neuropathic and nociceptive pain below the level of SCI as the primary trigger for AD episodes, which was confirmed through an extensive work-up and successful SCS trial.

Research Summary

This case report describes the successful use of spinal cord stimulation (SCS) to treat pain-induced autonomic dysreflexia (AD) in a 46-year-old female with chronic incomplete traumatic quadriplegia. After an extensive workup revealed neuropathic and nociceptive pain below the level of the spinal cord injury as the trigger for AD, SCS implantation led to a significant reduction in AD episodes and decreased opioid use. The findings suggest that SCS can be a valuable approach for managing intractable neuropathic pain and preventing potentially life-threatening AD episodes in spinal cord injury patients.

Practical Implications

Pain Management Strategy

SCS can be considered as an effective intervention for managing neuropathic pain in SCI patients, reducing reliance on opioids.

Autonomic Dysreflexia Prevention

Addressing neuropathic pain with SCS may help prevent AD episodes, improving patient quality of life and reducing the risk of severe complications.

Personalized Treatment Approach

Careful evaluation to identify the underlying causes of AD, such as neuropathic pain, is crucial for tailoring effective treatment strategies.

Study Limitations

1
Single case report limits generalizability.
2
Short follow-up period (3 months) may not reflect long-term outcomes.
3
Lack of a control group makes it difficult to definitively attribute improvement solely to SCS.

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