![]() When traditional SCS proves ineffective, switching to 10kHz stimulation should be considered. 11–19 Additionally, there is also growing evidence supporting the use of 10kHz SCS for patients with chronic back pain who are not interested in structural surgery or deemed not a surgical candidate. It can be used to treat a wide variety of neuropathic pain syndromes. SCS therapy is minimally invasive and reversible. When traditional intervention pain management procedures have been exhausted or the patient has persistent back pain after spine surgery, SCS should be explored as a potential option for providing pain relief. 1,7 When conservative management fails, interventional options should be considered in these patients. DiscussionĬhronic low back pain continues to affect the lives of hundreds of millions worldwide. The leads were pulled down so that the top contacts would cover the T9/10 disc space. Fluoroscopy images demonstrate lead revision. She proceeded to permanent implantation with similar results.įigure 1. ( Figure 1) The patient reported gradual improvement in her pain complaints and after another 4-day trial period she reported greater than 70% improvement in her pain complaints and improvement in her quality of sleep. The leads were pulled down so that the top 8 contacts covered the T9/10 disc space and the patient’s SCS leads were switched to over to Nevro and 10kHz stimulation. A fluoroscopy image was obtained demonstrating no lead migration. The patient reported dissatisfaction with her pain relief 4 days into her trial. She underwent a SCS trial placing two 16-contact leads at the top of the T7 vertebral body and paresthesia mapping for pain coverage. The patient underwent psychological testing and was deemed a good candidate for SCS trial for her chronic debilitating back pain complaints. She was being managed with intermittent trigger point injections along with pharmacological treatments including acetaminophen, NSAIDs, membrane stabilizers, muscle relaxers and opioids. She presented to the pain clinic after undergoing physical therapy for 6 months with no benefit along with multiple failed epidural steroid injections as well as radiofrequency ablation procedures without significant improvement in her pain complaints. The patient was a 66-year-old female who underwent a laminectomy and fusion at L4/5 several years prior for persistent back pain complaints not responsive to more conservative options. The patient ultimately achieved superior pain relief with 10kHz therapy. Here we describe our experience utilizing 10kHz therapy to salvage a failing SCS trial. 10 To avoid the use of paresthesias, a 10kHz waveform at a sub-perception threshold can be used to provide superior pain relief without the sensations provided by traditional SCS. However, the use of paresthesias in low frequency SCS may be uncomfortable or undesired by many patients. If the trial is successful, a permanent SCS is implanted. 10 The pulses generated by traditional SCS may create paresthesias that overlap in the region of pain. 10,11 Patients first undergo a SCS trial by placing electrodes in the epidural space with a temporary external power source to determine if the patient achieves relief. Spinal cord stimulator (SCS) is a Federal Drug Administration-approved treatment modality for treating persistent pain after spinal surgery, complex regional pain syndrome, and painful diabetic neuropathy. When surgical interventions such as back surgery fail to treat the source of pain, other options can be used to treat the resulting persistent pain after spinal surgery. Depending on the cause of the low back pain, minimally to more invasive techniques are used to target the source of low back pain. 8,9 When patients fail conservative management, the decision to pursue imaging to identify a source is then undertaken. The initial treatment of low back pain is conservative pharmacologic and nonpharmacologic management including, but not limited to, nonsteroid anti-inflammatory agents and physical therapy. 6,7 As the population ages, so will the overall number of sufferers of chronic low back pain and the costs associated. 5 The resulting economic burden, whether it be acute or chronic low back pain, can be quite substantial with estimates reaching well over $100 billion dollars annually not including the lost wages due to lack of productivity. 1–4 Often, the acute episode of low back pain will become chronic, lasting greater than 12 weeks. Over 80% of people will experience one or more episodes of low back pain at some point in their lives with many of these episodes self-resolving within 4-6 weeks. ![]()
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