Spinal cord stimulation for cancer-related low back pain. Treatment of cancer-related chest wall pain using spinal cord stimulation. Spinal cord stimulation in management of chronic pain. A 9-year experience. A family-based randomized controlled trial of pain intervention for adolescents with sickle cell disease.
At least one third of patients with cancer have pain at the time of their diagnosis. In an attempt to provide increased pain relief for patients with intractable cancer pain, unconventional agents and interventional procedures including spinal cord stimulation (SCS) have received considerable attention.
                Patients with cancer-related low back pain underwent an uneventful SCS trial with percutaneous placement of 2 temporary 8-electrode leads placed at the level of T8-T9-T10.
                After experiencing excellent pain relief during the 2-day trial, patients were subsequently implanted with permanent leads and generator with sustained pain relief at 12 months postoperation.
                Spinal cord stimulation provides an effective, alternative treatment option for select patients with cancer-related pain who have failed conservative treatment. it has been estimated that 15% to 40% of chronic cancer pain has a neuropathic component, and this type of pain often responds poorly to opioids. In an attempt to provide increased pain relief for patients with intractable cancer pain, unconventional agents and interventional management approaches have received considerable attention. Spinal cord stimulation (SCS) has been used with increased frequency for the treatment of intractable cancer pain.
                the patients with a history of cancer-related chest wall pain underwent an uneventful SCS trial with percutaneous placement of 2 temporary 8-electrode leads (Medtronic Inc, Minneapolis, Minnesota) placed at the level of T3-T4-T5.
                after experiencing excellent pain relief over the next 2 days, the patients were implanted with permanent leads and rechargeable generator 2 to 2 ½ weeks later and reported sustained pain relief at 12-month follow-up visit. Conclusion: SCS provides an effective, alternative treatment option for select patients with cancer-related chest wall pain who have failed conservative treatment. SCS may provide pain relief with advantages over conservative treatments and more invasive techniques. Between 1978 and 1986, 109 patients with chronic pain underwent spinal cord stimulation (SCS) at the authors' institute as part of their pain treatment program. The results of SCS in these patients at the end of the test period and at the latest follow-up examination are analyzed in relation to the etiology of their pain. In 40 patients pain was associated with an obstructive peripheral vasculopathy, in 10 with a previous herpes zoster infection, in 15 with an incomplete traumatic spinal cord lesion, in nine with root and/or nerve damage, in 11 with cancer, and in 19 with previous back surgery. The etiology of the pain in five patients was uncertain. This experience supports the conclusion that the best indications for SCS are vasculopathic pain and post-herpetic neuralgia. No clinical usefulness was found for SCS in cancer pain or in central deafferentation types of pain. The study had 2 aims---to determine the efficacy of a family-based cognitive-behavioral pain management intervention for adolescents with sickle cell disease (SCD) in (1) reducing pain and improving health-related variables and (2) improving psychosocial outcomes. Each adolescent and a family support person were randomly assigned to receive a brief pain intervention (PAIN) (n=27) or a disease education attention control intervention (DISEASE ED) (n=26) delivered at home. Assessment of primary pain and health-related variables (health service use, pain coping, pain-related hindrance of goals) and secondary psychosocial outcomes (disease knowledge, disease self-efficacy, and family communication) occurred at baseline (before randomization), postintervention, and 1-year follow-up. Change on outcomes did not differ significantly by group at either time point. When groups were combined in exploratory analyses, there was evidence of small to medium effects of intervention on health-related and psychosocial variables. Efforts to address barriers to participation and improve feasibility of psychosocial interventions for pediatric SCD are critical to advancing development of effective treatments for pain. Sample size was insufficient to adequately test efficacy, and analyses did not support this focused cognitive-behavioral pain management intervention in this sample of adolescents with SCD. Exploratory analyses suggest that comprehensive interventions, that address a broad range of skills related to disease management and adolescent health concerns, may be more effective in supporting teens during healthcare transition.
Current evidence is insufficient to establish the role of SCS in treating refractory cancer-related pain. Future randomised studies should focus on the implantation of SCS in patients with cancer-related pain.