Dorsal column stim - PHN

[MitchLevi]

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How does the group select levels for dorsal column stim in a pt with thoracic PHN? I have a T5-7 PHN pt and I'm doing a trial on this guy and I'm thinking of putting electrode one at T2 or 3.

Any ideas?

95% of what I stim is FBSS, and I don't see PHN but maybe 2-3 times per yr. Ortho practice.

 

[callmeanesthesia]

Same boat as you, and a very similar patient. Had already failed everything else except Qtenza, which she didn’t want to try and I’m not familiar enough with to play around with it. T2 is about what I did. And one lead midline, one a little to the side of the pain. She ended up liking a combo of high and low frequency on the trial, and seems to be having at least some relief from the implant so far (only about a month out as of last follow up).

 

[GoBeers]

how long do you wait for someone to continue experiencing PHN before making the call to stim? most cases resolve within a year

 

[MitchLevi]

how long do you wait for someone to continue experiencing PHN before making the call to stim? most cases resolve within a year

3 yrs this pt. Sent from the VA.

 

[callmeanesthesia]

Almost 2 years for mine. In general I’d wait at least a year after onset.

 

[MitchLevi]

Did T1-2 disk space. Entry at T4-5 lead one and T5-6 lead two. Let's see what happens.

 

[thecentral09]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

 

[RoloTomassi]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

Wow. How are you planning for growth, as that lead will drift down with height increase it seems?

 

[MitchLevi]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

Damn

 

[Agast]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

Immunocompromised?

 

[lobelsteve]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

University based care? What is the support system for this from logistics standpoint?

 

[Orin]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

Glad it helped and thanks for trying something for that kid.

Did you try perc PNS first?
Are you planning on an EPG or a conventional IPG system?

 

[painfree23]

Just finished a seven day trial on a nine-year-old who has had postherpetic neuralgia for approximately five years. He states approximately 80% improvement during the trial, T4 Dash T5 dermatomal pain, top of lead was at T1, single lead. Will do implant in four weeks.

Which system? Paresthesia?

 

[Ducttape]

do you mean ninety-year-old?

a nine year old that had PHN for 5 years... that would mean that he got it at age 4.

 

[thecentral09]

do you mean ninety-year-old?

a nine year old that had PHN for 5 years... that would mean that he got it at age 4.

Ahhhhh yep

 

[Agast]

Ahhhhh yep

Dude I was sooooo confused

Thank god there isn’t some poor child with PHN and a stimulator

 

[MitchLevi]

I was wondering what that IPG pocket looks like.

 

[Ducttape]

Dude I was sooooo confused

Thank god there isn’t some poor child with PHN and a stimulator

hey... dont give any chiros that idea!

 

[MitchLevi]

hey... dont give any chiros that idea!

I'm laughing about that, but I'm not truly laughing about that after thinking about it.