Mamaril-Davis James, Palsma Ryan, Weinand Martin
College of Medicine, The University of Arizona College of Medicine - Tucson, Tucson, AZ, USA.
Department of Neurosurgery, Banner University Medical Center/University of Arizona, Tucson, AZ, USA.
Case Rep Gastroenterol. 2025 Jun 18;19(1):461-466. doi: 10.1159/000546229. eCollection 2025 Jan-Dec.
Spinal cord stimulation (SCS) for chronic abdominal pain is not novel. However, this has been explored only when the pain has a clear dermatomal association such as the right upper quadrant for sphincter of Oddi dysfunction or the left upper quadrant for post-traumatic splenectomy. The present report thereby discusses the utility of SCS when the visceral pain is diffusely distributed across all four quadrants of the abdomen.
A patient in their 70s presented with a 30-year history of chronic abdominal pain diffusely located in all four quadrants. The patient had a pancreatic cyst removed via pancreaticoduodenectomy in 1991 complicated by chronic pancreatitis and visceral hyperalgesia. After failed pharmacological management and various outpatient nerve blocks and trigger point injections, the patient underwent SCS placement via five 4-contact paddle leads at the mid- to superior thoracic 7 level. At 1-month follow-up, the patient's visual analog scale score decreased from 8/10 (prior to implantation) to 0/10. The patient also discontinued his chronic opioid regimen post-SCS placement but continued duloxetine. Device settings remained the same throughout the postoperative period: pulse width of 500 microseconds (inter-burst) and 1,000 microseconds, frequency of 40 Hertz, and current of 1.7 milliamperes. At 12-month follow-up, the patient continued to report >90% pain relief at nearly the same SCS settings as the initial programming.
SCS may be a reliable treatment option for chronic abdominal, visceral hyperalgesia when the pain is diffusely located in all 4 quadrants and without a clear dermatomal pattern.
脊髓刺激（SCS）用于慢性腹痛并非新鲜事物。然而，仅在疼痛具有明确的皮节关联时才进行探索，例如Oddi括约肌功能障碍的右上腹或创伤后脾切除术的左上腹。本报告因此讨论了在内脏疼痛广泛分布于腹部所有四个象限的情况下SCS的效用。
一名70多岁的患者，有30年慢性腹痛病史，疼痛广泛分布于所有四个象限。该患者于1991年接受了胰十二指肠切除术以切除胰腺囊肿，术后并发慢性胰腺炎和内脏痛觉过敏。在药物治疗失败以及各种门诊神经阻滞和触发点注射均无效后，患者于胸7中上部水平通过五条4触点片状电极导线进行了SCS植入。在1个月的随访中，患者的视觉模拟评分从植入前的8/10降至0/10。患者在SCS植入后也停用了慢性阿片类药物治疗方案，但继续服用度洛西汀。术后整个期间设备设置保持不变：脉冲宽度为500微秒（脉冲间期）和1000微秒，频率为40赫兹，电流为1.7毫安。在12个月的随访中，患者继续报告在与初始编程几乎相同的SCS设置下疼痛缓解>90%。
当疼痛广泛分布于所有四个象限且无明确皮节模式时，SCS可能是慢性腹部内脏痛觉过敏的可靠治疗选择。
