A Real-World Analysis of High-Frequency 10 kHz Spinal Cord Stimulation for the Treatment of Painful Diabetic Peripheral Neuropathy.

BACKGROUND: Diabetes is one of the most prevalent chronic health conditions and diabetic neuropathy one of its most prevalent and debilitating complications. While there are treatments available for painful diabetic peripheral neuropathy (pDPN), their effectiveness is limited. METHOD: This retrospective, multi-center, real-world review assessed pain relief and functional improvements for consecutive patients with diabetic neuropathy aged ≥18 years of age who were permanently implanted with a high-frequency (10 kHz) spinal cord stimulation (SCS) device. Available data were extracted from a commercial database. RESULTS: In total 89 patients consented to being included in the analysis. Sixty-one percent (54/89) of participants were male and the average age was 64.4 years (SD = 9.1). Most patients (78.7%, 70/89) identified pain primarily in their feet or legs bilaterally. At the last assessment, 79.5% (58/73) of patients were treatment responders, defined as having at least 50% patient-reported pain relief from baseline. The average time of follow-up was 21.8 months (range: 4.3 to 46.3 months). A majority of patients reported improvements in sleep and overall function relative to their baseline. CONCLUSIONS: This real-world study in typical clinical practices found 10 kHz SCS provided meaningful pain relief for a substantial proportion of patients refractory to current pDPN management, similar to published literature. This patient population has tremendous unmet needs and this study helps demonstrate the potential for 10 kHz SCS to provide an alternative pain management approach.

An innovative case report detailing the successful treatment of post-thoracotomy syndrome with peripheral nerve field stimulation.

INTRODUCTION: The detrimental effects of post-thoracotomy pain syndrome is experienced worldwide; however, an effective treatment regimen remains elusive. METHODS: We report a case of post-thoracotomy pain syndrome effectively treated with peripheral nerve field stimulation (PNfS). RESULTS: In the presented case, the patient underwent permanent placement of the PSfS device after a successful trial period. Upon follow-up the patient has reported even better coverage over her painful areas and admits to 80% and higher reductions in her painful symptoms. CONCLUSION: Although the data are limited, in the aforesaid case report, post-thoracotomy syndrome was effectively treated with the use of PNfS. This resulted in a significant pain perception reduction, increased quality of life and mobility, as well as decreased usage of oral pain medications. This adds to the accumulating case report and case series data that suggest PNfS is showing great promise as a pain reduction modality. Further, it is minimally invasive, can be trialled prior to implantation, and is reversible. Large prospective studies will be required in the future to further evaluate its efficacy before it can be widely accepted and adopted.

Sacral nerve stimulation as a treatment modality for intractable neuropathic testicular pain.

BACKGROUND: Chronic testicular pain, or "chronic orchalgia," is defined as testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient. For patients failing to respond to conservative treatment, microsurgical denervation of the spermatic cord, epididymectomy, and vasovasostomy have all shown a degree of relief. However, these are all invasive procedures and no treatment has proven efficacy when these options fail. We present a case of a male who presented with over a decade of chronic right-sided testicular pain secondary to recurrent epididymitis. Before arriving at our clinic the patient had an epididymectomy performed with no appreciable improvement in pain. Initially ilioinguinal, iliohypogastric, and genetofemoral nerve blocks; right-sided S1, S2, and S3 transforaminal epidural steroid injections (TFESIs) with inferior hypogastric blocks; and right-sided T12-L1, L1-L2, and L2-L3 TFESIs all failed to provide pain relief. After conservative therapies had failed, a sacral nerve stimulation trial was done via a caudal epidural approach. The permanent implant has provided the patient with sustained 80% decrease in pain at 4 months status post permanent sacral nerve stimulation implant. The above case demonstrates the potential benefit of sacral nerve stimulation with neuropathic intractable testicular pain in a patient that failed conservative treatment. In this case, the patient had exhausted medical and surgical management, including advanced interventional pain options. We were unable to find any previous published cases of neurostimulation used as a modality of treatment for testicular pain, and further studies are needed to gain a better understanding of the efficacy in this setting.