Help with SCS lead location

[predentalgirl]

Need some ideas.
I have a patient that has a history of rectal pain/tailbone pain. 77 year old male, history of L4-L5 laminectomy 15 years ago - essentially not complaining of much back pain. Had some urological procedure (i think prostate biopsy) successfully, but then started having some discomfort in tailbone area a couple of months later. Was sent to physical therapy and they put some type of probe in his rectum (YES YOU READ THAT RIGHT) and manipulated it for some god awful reason and he’s been in tremendous pain since then.

He’s had a ganglion impair block with minimal relief, straight coccyx injection with no relief, lesi at L5-S1 with no relief. Gabapentin, tca, all adjuvant medications are not working, doesn’t tolerate opioids.

For scs stimulation where would your target area be? Sacral nerves, T12-L3 area?

Thoughts?

EDIT: seems like i posted under my wife’s username; as she was signed in on my iPad

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[lobelsteve]

Nevro. Span T9-10, T10-11.

 

[No Pain All gain]

First, take the probe out of his rectum (if you didn't already think of that).

Second, neurostimulation may be an option. I would recommend considering a multivendor trial with medtronic electrodes since everyone else has converted. DTM stimulation can be assessed, and consider 10 Khz next. Another consideration would be to look at the MRI L-spine images and see if he had a hemilami, in whihc case you can put a retrograde lead in at L1-2 or L2-3 down to the sacrum and an anterograde lead to T9-10. I have had some success with this. If considering this strategy, my recommendation is to trial with 3 electrodes and to have the company give you one for free. In my opinion this is a better choice than starting with DRG stimulation given the age of the patient, need for future MRIs, and relatively narrow therapeutic option (as compared to trialing every SCS waveform using medtronic leads and other external generators).

 

[NJPAIN]

First, take the probe out of his rectum (if you didn't already think of that).

Second, neurostimulation may be an option. I would recommend considering a multivendor trial with medtronic electrodes since everyone else has converted. DTM stimulation can be assessed, and consider 10 Khz next. Another consideration would be to look at the MRI L-spine images and see if he had a hemilami, in whihc case you can put a retrograde lead in at L1-2 or L2-3 down to the sacrum and an anterograde lead to T9-10. I have had some success with this. If considering this strategy, my recommendation is to trial with 3 electrodes and to have the company give you one for free. In my opinion this is a better choice than starting with DRG stimulation given the age of the patient, need for future MRIs, and relatively narrow therapeutic option (as compared to trialing every SCS waveform using medtronic leads and other external generators).

If you are doing this type of multivendor trial, how long are you trialing each waveform?

 

[Agast]

What probe is inserted during PT for tailbone pain??

 

[No Pain All gain]

If you are doing this type of multivendor trial, how long are you trialing each waveform?

Until success or patient wishes to stop. We do extensive counseling on each device and they usually have a “lineup” based on other features.

In general, 3 days or maybe 4 per waveform.