Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
Medicine (Baltimore). 2021 Feb 12;100(6):e24628. doi: 10.1097/MD.0000000000024628.
Central neuropathic pain can result from any type of injury to the central nervous system. Treatment of central neuropathic pain is very challenging. Recently, a novel stimulation paradigm, called burst stimulation, has been presented as an excellent alternative in a group of patients with intractable central neuropathic pain. We report 2 cases where burst spinal cord stimulation (SCS) was applied in patients with neuropathic pain due to spinal cord injury (SCI) or traumatic brain injury.
A 52-year-old man who underwent posterolateral fusion surgery for a T12 bursting fracture after a fall 11 years prior developed disabling pain in the anterolateral part of his right thigh. His neuropathic pain following SCI was refractory to various treatment modalities. A 65-year-old man had complained of intractable, cold, throbbing, and shooting pain mainly in his left lower limb during rehabilitation since undergoing a craniotomy 9 years prior for multiple brain injuries caused by a motorcycle accident.
Both of these 2 cases were diagnosed with central neuropathic pain syndrome caused by SCI or traumatic brain injury.
Burst SCS were proposed to alleviate the significant refractory pains that were resistant to various medications and stimulation was delivered to the patient in an alternating pattern between traditional tonic and burst waveforms.
The efficacy of burst SCS in central neuropathic pain is desirable considering the severity of pain in such patients, the refractory nature of their pain, and the paucity of alternative therapeutic options.
中枢性神经性疼痛可由中枢神经系统的任何类型损伤引起。中枢性神经性疼痛的治疗极具挑战性。最近，一种新型刺激模式，即爆发刺激，已被提出作为一组难治性中枢神经性疼痛患者的极佳替代方案。我们报告了 2 例因脊髓损伤（SCI）或创伤性脑损伤导致神经性疼痛的患者应用爆发性脊髓刺激（SCS）的情况。
一名 52 岁男性，11 年前因坠落导致 T12 爆裂性骨折行后路融合手术后，出现右大腿前外侧部位严重疼痛。他的 SCI 后神经性疼痛对各种治疗方法均无反应。一名 65 岁男性，9 年前因摩托车事故导致多发脑损伤而行开颅手术后，一直在进行康复治疗，一直抱怨左下肢难以忍受的冷、搏动性和刺痛性疼痛。
这 2 例患者均被诊断为 SCI 或创伤性脑损伤引起的中枢神经性疼痛综合征。
提出应用爆发 SCS 来缓解对各种药物均有抗性的显著难治性疼痛，以交替的传统持续刺激和爆发刺激波形向患者传递刺激。
考虑到这些患者疼痛的严重程度、疼痛的难治性以及缺乏替代治疗方案，爆发 SCS 在中枢神经性疼痛中的疗效是理想的。
