2019 FSA Posters

P058: BEYOND MULTIMODAL MEDICATION: CASE REPORT OF SPINAL CORD STIMULATOR PLACED FOR NEUROPATHIC ABDOMINAL PAIN ORIGINATING FROM A TUMOR INVADING THE CELIAC PLEXUS
Jeffrey R Pence, DO, Ajay Antony, MD; University of Florida

Introduction: According to the International Neurmodulation Society spinal cord stimulation (SCS) provides 50% or more pain relief in over 80% of patients, with 70% of patients achieving 80% pain relief or more.  It has been reported that over four times as many patients treated with spinal cord stimulation are successes rather than failures¹. The most common indications for SCS are post-laminectomy syndrome and complex regional pain syndrome. One type of pain that has historically been difficult to address is neuropathic abdominal pain. SCS may offer an effective and cost-effective treatment option. We present of case of neuropathic abdominal pain secondary to non-malignant tumor invasion of the celiac plexus and how a multidisciplinary approach benefited this patient.

Case: The patient is a 59-year-old African American male with a past medical history of retroperitoneal plexiform neurofibroma, chronic DVTs of both lower extremities s/p IVC filter placement. Patient diagnosed with neurofibroma in 1993 and was treated for several years with high dose opioids, tumor debulking surgery, and celiac plexus blocks. After failing these options, he was evaluated for a spinal cord stimulator. After a successful SCS trial with mid thoracic dorsal column leads using paresthesia-free amplitudes with burst stimulation, the patient was implanted with percutaneous leads (lead tip locations of T4-5 and T5-6). The result was significant pain relief with reduction of his pain from 6/10 to 0/10, opioid reduction, and no further need for celiac plexus blocks.

Discussion: As part of a multidisciplinary approach, SCS may provide some patients that suffer from neuropathic abdominal pain with pain relief that cannot be found with medications alone.

References:

Levy, R.M. (2018, December). International Neuromodulation Society Statement on News Articles Concerning Spinal Cord Stimulation. Retrieved from https://www.neuromodulation.com/assets/ins-statement-concerning-news-articles-about-spinal-cord-stimulation.pdf

Krames E et al. Using the SAFE principles when evaluating electrical stimulation therapies for the pain of failed back surgery syndrome. Neuromodulation 2011:14:299-311