Neuroanatomical and physiological data in a larger population of patients will be required to predict the best responders to this therapeutic modality.Ĭentral Pain, Multiple Sclerosis, Spinal Cord Stimulation IntroductionĬentral pain may result from a lesion to somatosensory pathways at nearly any level of the central nervous system. Lateral-lead spinal cord stimulation may be effective for some central pain syndromes through a partial restoration of homeostatic small-fiber signaling. The patient's questionnaire responses indicated significantly improved pain scores with lateral-lead neuromodulation that was associated with a reduction in her baseline heat hypoalgesia.Ĭonclusions. Responses on the Brief Pain Inventory short form and quantitative thermosensory testing data were collected at two timepoints 16 days apart under two conditions: no stimulation and single-lead stimulation of cervical primary afferents and underlying spinal cord. One year after an unsuccessful single-lead trial of spinal cord stimulation over the cervical dorsal columns, a dual-lead trial of spinal cord stimulation over the lateral cervical spinal cord and dorsal roots provided significant analgesia, prompting a successful permanent implant. Medications, sympathetic blocks, and acupuncture had been ineffective. A 52-year-old woman presented with a 2-year history of pain in the lateral hand secondary to a demyelinating episode in the C2–4 spinal cord secondary to multiple sclerosis. The rationale for this technique based on current understanding of the mechanisms of central pain and the risk/benefit considerations are discussed.Ĭase Report. Neuromodulation of primary afferent fibers and the underlying dorsal root entry zone provided effective analgesia whereas traditional lead placement over the dorsal columns on a prior occasion had not been effective. We report a case of central pain successfully treated by epidural placement of spinal cord stimulator electrodes.
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