Spinal Cord Stimulators

Spinal cord stimulators apply a small electrical input via electrodes placed next to the spinal cord. They are surgically placed into the epidural space next to the spinal cord at a site that has been previously determined in a trial procedure to decrease pain. However, there is a high rate of movement of the electrodes, so they frequently migrate from the original place over the spinal cord. In complex regional pain syndrome (CRPS) they have been reported to transiently decrease the pain. They do not prevent the spread of CRPS. There have been no Cochrane systematic reviews of spinal cord stimulators in amplified pain syndromes, but there was one done pertaining to their use in cancer related pain that concluded there was insufficient evidence for the use of spinal cord stimulators in treating refractory cancer related pain. In one study, seven children with amplified pain had spinal cord stimulators implanted; two had no benefit, one had an infection and the rest experienced benefit. In another report, six children had only mild improvement or worsening of their pain with the spinal cord stimulator.

Because this is a surgical procedure, there are many side effects possible, including some that are quite serious. Reported side effects include spinal fluid leakage, urinary retention, conversion disorder, panic attacks, priapism (prolonged erections), infection, skin cancer and paralysis. One patient had permanent neurological damage when the spinal cord stimulator was uncontrollably activated by an antitheft device at a store.

It has been argued that since most children do well with conventional therapies (exercise therapy and counseling) invasive therapies should be avoided.

  1. Kumar K, Rizvi S, Bnurs SB. Spinal cord stimulation is effective in management of complex regional pain syndrome I: fact or fiction. Neurosurgery 2011;69:566-78; discussion 5578-80.
  2. Osborne MD, Ghazi SM, Palmer SC, Boone KM, Sletten CD, Nottmeier EW. Spinal cord stimulator–trial lead migration study. Pain Medicine 2011;12:204-8.
  3. Aldrete JA, Vascello LA, Ghaly R, Tomlin D. Paraplegia in a patient with an intrathecal catheter and a spinal cord stimulator. Anesthesiology 1994;81:1542-5; discussion 27A-28A.
  4. Arxer A, Busquets C, Vilaplana J, Villalonga A. Subacute epidural abscess after spinal cord stimulator implantation. European Journal of Anaesthesiology 2003;20:755-7.
  5. Falowski S, Ooi YC, Sabesan A, Sharan A. Spinal cord injury induced by a cervical spinal cord stimulator. Neuromodulation 2011;14:34-6; discussion 6-7.
  6. Gilbert JW, Wheeler GR, Mick GE, Herder SL, Richardson GB. Paraparesis following spinal cord stimulator trial, implantation and revision. Pain Physician 2010;13:E377.
  7. Han D, Connelly NR, Weintraub A, Kanev P, Solis E. Conversion locked-in syndrome after implantation of a spinal cord stimulator. Anesthesia & Analgesia 2007;104:163-5.
  8. Pope JE, Stanton-Hicks M. Accidental subdural spinal cord stimulator lead placement and stimulation. Neuromodulation 2011;14:30-2
  9. Zdanowicz N, Janne P, Reynaert C, Wunsch A. Induction of a schizophreniform disorder by a spinal cord stimulator. Psychosomatics 1999;40:76-8.
  10. Eisenberg E, Waisbrod H. Spinal cord stimulator activation by an antitheft device. Case report.[Erratum appears in J Neurosurg 1998 Apr;88(4):791]. Journal of Neurosurgery 1997;87:961-2.
  11. Olsson GL, Meyerson BA, Linderoth B. Spinal cord stimulation in adolescents with complex regional pain syndrome type I (CRPS-I). European Journal of Pain 2008;12:53-9.
  12. Wilder RT, Wilder RT. Management of pediatric patients with complex regional pain syndrome. Clinical Journal of Pain 2006;22:443-8.
  13. Lihua P, Su M, Zejun Z, Ke W, Bennett MI. Spinal cord stimulation for cancer-related pain in adults. The Cochrane database of systematic reviews 2013;2:Cd009389.Zernikow B, Dobe M, Hirschfeld G, Blankenburg M,
  14. Reuther M, Maier C. [Please don’t hurt me!: a plea against invasive procedures in children and adolescents with complex regional pain syndrome (CRPS)]. Der Schmerz 2012;26:389-95.

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