Subcutaneous Target Stimulation (STS) in Chronic Noncancer Pain: A Nationwide Retrospective Study

Pain Practice Volume 10 Issue 4, Pages 279 - 286

Published Online: 3 Mar 2010
Journal compilation © 2010 World Institute of Pain
Sabine Sator-Katzenschlager, MD*; Katharina Fiala, MD*; Hans G. Kress, MD, PhD*; Alexandra Kofler, MD † ; Josef Neuhold, MD ‡ ; Herwig Kloimstein, MD § ; Wilfried Ilias, MD ¶ ; Eva-Maria Mozes-Balla, MD**; Michaela Pinter, MD †† ; Nadja Loining, MD † ; Wolfgang Fuchs, MD § ; Georg Heinze, PhD ‡‡ ; Rudolf Likar, MD §§


*Department of Special Anesthesia and Pain Therapy, Medical University of Vienna, Vienna, Austria, † Clinical Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria, ‡ Department of Anaesthesiology, Intensive Care and Pain Therapy, Krankenhaus der Elisabethinen Graz, Graz, Austria, § Department of Anesthesiology and Intensive Care Medicine, Pain Management Centre, General Hospital Linz, Linz, Austria, ¶ Department of Anesthesiology, Intensive Care and Pain Therapy, Krankenhaus der Barmherzigen Brüder, Vienna, **Department of Neurosurgery, Academic Teaching Hospital Feldkirch, Feldkirch, Austria, †† Neurological Rehabilitation Centre Rosenhuegel, Vienna, ‡‡ Core Units for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria, §§ Department of Anaesthesiology and Intensive Medicine, Interdisciplinary Center of Pain Therapy and Palliative Medicine, General Hospital Klagenfurt, Klagenfurt, Austria


Correspondence to Sabine Sator-Katzenschlager, MD, Department of Special Anesthesia and Pain Therapy, Medical University of Vienna, AKH Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: sabine.sator-katzenschlager@meduniwien.ac.at.

Copyright Journal compilation © 2010 World Institute of Pain

ABSTRACT

Stimulation of primary afferent neurons offers a new approach for the control of localized chronic pain. We describe the results with a new neurostimulation technique, subcutaneous target stimulation (STS), for the treatment of chronic focal noncancer pain. STS applies permanent electrical stimulation directly at the painful area via a percutaneous-placed subcutaneous lead. We reported the clinical outcomes of 111 patients with focal chronic, noncancer pain treated with STS in this first nationwide, multicenter retrospective analysis. The indications for STS were low back pain (n = 29) and failed back surgery syndrome (back pain with leg pain) (n = 37), cervical neck pain (n = 15), and postherpetic neuralgia (n = 12). Pain intensity was measured on a numerical rating scale (NRS) before and after implantation. Data on analgesic medication, stimulation systems, position, and type of leads and complications were obtained from the patients' records. After implantation, the mean pain intensity improved by more than 50% (mean NRS reduction from 8.2 to 4.0) in the entire patient group (P = 0.0009). This was accompanied by a sustained reduction in demand for analgesics. In all the patients, the STS leads were positioned directly at the site of maximum pain. Lead dislocation occurred in 14 patients (13%), infections in 7 (6%), and in 6 cases (5%), lead fractures were observed. The retrospective data analysis revealed that STS effectively provided pain relief in patients suffering from refractory focal chronic noncancer pain and that STS is an alternative treatment option. Prospective controlled studies are required to confirm these retrospective findings. This article presents a new minimally invasive technique for therapy-resistant focal pain.
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Submitted: October 3, 2009; Accepted: December 6, 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1533-2500.2009.00351.x About DOI