Spinal cord stimulation for visceral pain associated with medullary sponge kidney.

Chronic pain is a common reason for which people in the USA seek medical care. It is linked to opioid consumption, anxiety and a reduction in quality of life. Over the past 50 years, spinal cord stimulation (SCS) has evolved as a safe and efficacious treatment for chronic pain etiologies. The authors present the first known case of SCS for pain due to medullary sponge kidney disease. This report adds to the growing body of literature supporting the use of SCS for treating visceral organ pain, while also highlighting the utility of ventral lead placement for treating visceral pain. As SCS utilization increases, it is expected that there will be a decrease in opioid consumption, and this will help us contain the opioid epidemic.

Chronic pain is one of the most common reasons that people in the USA seek medical care. It is associated with an increased reliance on opioids, anxiety, depression and a lower quality of life. Over the past 50 years, a treatment modality known as spinal cord stimulation (SCS) has emerged and evolved. Based on evidence, SCS has shown promising results in treating chronic pain related to different causes and has also led to an improvement in the quality of life in those suffering from pain. In this case report, the authors present a case of a patient with chronic pain due to recurrent kidney stones secondary to their hereditary kidney disease, and who responded well to treatment with SCS. The patient self-reported almost 80% pain relief after undergoing treatment with SCS as well as an improved quality of life, based on their ability to engage in their daily professional and leisurely activities without being so restricted by pain from their recurrent kidney stones. This case report adds to the growing body of literature that underscores the utility of SCS in treating a variety of pain mediated pathologies. As SCS continues to show promising results, we hope that SCS usage to target pain will increase, and this will lead to a decrease in opioid prescriptions and help curb the opioid epidemic.

The use of ketamine infusion to dramatically reduce opioid requirements in a patient whose high-dose intrathecal opioid pump was inadvertently cut during surgery.

BACKGROUND: Chronic opioid therapy may lead to high level tolerance development, hyperalgesia, and central sensitization, which further complicates long-term therapeutic management of chronic pain patients. In this case, we encounter a patient who was receiving over 15,000 morphine milligram equivalents through their intrathecal pain pump. Unfortunately, the intrathecal pump was inadvertently cut during a spinal surgery. It was deemed unsafe to delivery IV equivalent opioid therapy in this case; instead, the patient was admitted to the ICU and given a four-day ketamine infusion. METHOD: The patient was started on a ketamine infusion at a rate of 0.5mg/kg/h, which was continued for three days. On the fourth day, the infusion rate was tapered over 12 h before being completely stopped. No coinciding opioid therapy was given during this time, which was only restarted in the outpatient setting. RESULTS: Despite chronic high levels of opioid therapy immediately prior to the ketamine infusion, the patient did not experience florid withdrawals during the infusion period. Additionally, the patient experienced remarkable improvement in their subjective pain rating, which decreased from 9 to 3-4 on an 11-point Number Rating Scale, while simultaneously being managed on an MME <100. These results were sustained through a 6-month follow-up period. CONCLUSION: Ketamine may play an important role in attenuating not only tolerance but also acute withdrawal in a setting where rapid or instant weaning from high dose chronic opioid therapy is needed.

Successful spinal cord stimulation for chronic pancreatitis and post-laminectomy pain.

Approximately one in five adults in the United States experiences chronic pain. Over the last 50 years, spinal cord stimulation has become increasingly recognized as a minimally invasive, efficacious treatment modality for the management of chronic pain. The authors report a case study of a 46-year-old female in the first documented spinal cord stimulation simultaneously targeting intractable neuropathic and visceral pain caused by post-laminectomy syndrome and chronic pancreatitis, respectively. This case study demonstrates near-total relief of the patient's neuropathic low back/leg pain and visceral epigastric pain, showing evidence of potential clinical usefulness for spinal cord stimulation as a treatment option in patients who present with a combination of visceral and somatic pain symptoms.

Lay abstract Approximately one in five adults in the United States experiences chronic pain. Over the last 50 years, a treatment for chronic pain referred to as spinal cord stimulation has become a promising alternative to back surgery and may minimize the need for strong opioid pain medications. The authors report a case study of a 46-year-old female patient who suffered from chronic pain following back surgery as well as persistent pain from chronic pancreatitis. This case study demonstrates the use of spinal cord stimulation to provide near-total relief of the patient's low back/leg pain and pain from visceral inflammatory symptoms.