Abd pain and SCS

[soccerpunk600]

Anyone have any experience with chronic abdominal pain and spinal cord stim? I have a patient who has crohn's dx, tried celiac block in past w/o relief. I'm scratching my head to what I can offer him. Really reasonable patient, no interest in narcs or anything. I'm a newly practicing, so unfortunately don't have DRG training yet. Any thoughts or positive experience with convention stim for these type of patients?

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[unchockey21]

Anyone have any experience with chronic abdominal pain and spinal cord stim? I have a patient who has crohn's dx, tried celiac block in past w/o relief. I'm scratching my head to what I can offer him. Really reasonable patient, no interest in narcs or anything. I'm a newly practicing, so unfortunately don't have DRG training yet. Any thoughts or positive experience with convention stim for these type of patients?

Had great results with Nevro in fellowship. Need to make sure his Crohn's is stable though.

 

[oreosandsake]

Kapural published case series of 20 ish patients with abdominal and pelvic pain treated with scs worth looking up for reference

 

[lobelsteve]

Seen several. Explanted all of them. No sustained relief. Never trialed or implanted for this.

 

[Tapspatellas]

I hear people doing crazy stuff all the time with traditional stim and what sounds like pretty mediocre results. Anterior leads with posterior or lateral and posterior, things like that. I haven't done any but I'd be interested in HF trial for some. Main thing will be deciding upon neural target selection

 

[Ducttape]

did initally try, and got approval a couple o' times. no good results. none of them went to implant.

the data from Europe regarding unstable angina is better...

 

[NJPAIN]

Had great results with Nevro in fellowship. Need to make sure his Crohn's is stable though.

Very good point. I have a son with Inflammatory Bowel Disease so I am very familiar with it. If the patient is symptomatic you must question if the therapy is adequate unless the pain is more related to abdominal wall issues related to surgery. Also keep in mind that symptomatic relief alone is NOT considered as adequate treatment. What is important is achieving deep mucosal healing (for many reasons including reducing the risk of malignancy). So it is important for you and your patient to realize that if by some chance you reduce his symptoms with SCS you are not treating the disease. There are a lot of patients looking to avoid the disease modifying immunomodulatory and anti -TNF drugs who may be poorly informed and think that symptom control equals disease control. I suppose it is a different story if therapy is "maxed out" and the patient is on and off of steroids but I would tread very carefully if the patient says I want to try SCS to control my abdominal pain because I don't want to be on the powerful drugs.


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[soccerpunk600]

Very good point. I have a son with Inflammatory Bowel Disease so I am very familiar with it. If the patient is symptomatic you must question if the therapy is adequate unless the pain is more related to abdominal wall issues related to surgery. Also keep in mind that symptomatic relief alone is NOT considered as adequate treatment. What is important is achieving deep mucosal healing (for many reasons including reducing the risk of malignancy). So it is important for you and your patient to realize that if by some chance you reduce his symptoms with SCS you are not treating the disease. There are a lot of patients looking to avoid the disease modifying immunomodulatory and anti -TNF drugs who may be poorly informed and think that symptom control equals disease control. I suppose it is a different story if therapy is "maxed out" and the patient is on and off of steroids but I would tread very carefully if the patient says I want to try SCS to control my abdominal pain because I don't want to be on the powerful drugs.


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Great advice. Will definitely speak to him about all that. Thanks!