Peripheral subcutaneous field stimulation for the treatment of spinal cord injury at-level pain: case report, literature review, and 5-year follow-up

Heliyon, 2020 · DOI: https://doi.org/10.1016/j.heliyon.2020.e04515 · Published: July 16, 2020

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Spinal cord injuries can cause chronic pain that is hard to treat with medication. Peripheral subcutaneous field stimulation (PSFS) is a new surgical option. PSFS involves placing electrodes under the skin in the painful area to deliver electrical stimulation. This case report describes a man with spinal cord injury pain who found relief with PSFS. The patient experienced significant pain reduction and was able to stop taking narcotics. This suggests PSFS could be a helpful treatment for spinal cord injury pain, but more research is needed.

Study Duration

5 years

Participants

1 patient (case report) and a literature review of 260 patients

Evidence Level

Level 4: Case Report and Literature Review

Key Findings

1
A patient with SCI at-level pain experienced near complete pain relief with PSFS and ceased all narcotic use for pain management.
2
Literature review identified 14 studies investigating PSFS for chronic back pain, showing significant pain reduction in most patients.
3
PSFS may be particularly useful in targeting regions of pain where conventional SCS use has been shown to be ineffective or limited.

Research Summary

This paper presents a case report of a patient with spinal cord injury (SCI) at-level pain who was successfully treated with peripheral subcutaneous field stimulation (PSFS) and a literature review of PSFS for back pain. The case report details a 26-year-old man with complete paraplegia due to a T4 burst fracture who experienced significant pain relief and cessation of opioid use after PSFS implantation. The literature review identifies 14 studies supporting the use of PSFS for chronic back pain, showing significant pain reduction and reduced analgesic consumption in many patients.

Practical Implications

Pain Management

PSFS represents a potential alternative or adjunct therapy for chronic pain, especially in cases refractory to conventional treatments.

Spinal Cord Injury Rehabilitation

PSFS could improve quality of life for SCI patients suffering from intractable at-level pain, enabling better engagement in rehabilitation programs.

Future Research

The findings support the need for prospective, randomized controlled trials to further evaluate the efficacy and mechanisms of PSFS for SCI-related pain.

Study Limitations

1
Lack of prospective, observational, randomized controlled studies in the literature.
2
Noticeable lack of basic research on PSFS mechanisms of action in treating chronic pain.
3
Case series may amplify the treatment affect and mitigate complication rates.

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