게시판
| 21KS-002 |
Burst stimulation of the thoracic spinal cord near a cardiac pacemaker in an elderly patient with postherpetic neuralgia
고려대학교 구로병원 의과대학 마취통증의학교실
Introduction : Previous case reports indicate that caution should be exercised when performing SCS implantation in patients with permanent cardiac pacemakers. In the 2000s, safe methods of performing SCS in patients with PCP were reported, along with evidence of stability, including the use of the bipolar mode. However, research on the safety of new modes of SCS, such as burst mode, in patients with PCP is still insufficient.
We report a case in which effective and safe pain control was achieved without complications using burst-mode SCS in an elderly patient with PCP and well-established PHN in the thoracic region.
Case report : This study was approved by the Institutional Review Board of the Korea University Medical Center, Guro on February 11, 2019. The patient was an 80-year-old man who had a permanent cardiac pacemakers (PCP) implanted 3 months prior to admission because of complete atrioventricular block. He was diagnosed with acute HZ because he had a painful blister with a visual analog scale (VAS) score ≥9 on the second left thoracic dermatome. On day 180 of the rash, SCS was suggested to relieve the uncontrolled pain. Pacemaker sensitivity and possible interference between PCP and SCS were tested during the SCS trial in the operating room. No interference between the PCP and SCS was observed during the SCS trial in the operating and recovery rooms. The patients reported pain reduction more significantly in burst mode SCS than in tonic mode SCS and opted for permanent burst mode SCS implantation. 1 month after insertion of the SCS, VAS score was consistent at 3, and the patient reduced the dose of narcotic analgesic. At follow-up 6 months after SCS insertion, the patient showed pain relief of approximately 50%.
Conclusion : This case report indicates that burst mode SCS can be an effective and safe treatment for patients with intractable PHN with PCPs. Thorough monitoring to detect the interference between the two devices is a prerequisite for the simultaneous and safe use of burst-mode SCS and PCP.
Reference :
1. Sim, W.; Choi, J.; Han, K.; Kim, Y. Treatment of Herpes Zoster and Postherpetic Neuralgia. Korean J. Pain 2008, 21, 93-105.
2. Dworkin, R.; Gnann, J.; Oaklander, A.; Raja, S.; Schmader, K.; Whitley, R. Diagnosis and Assessment of Pain Associated with Herpes Zoster and Postherpetic Neuralgia. J. Pain 2008, 9, S37-S44.
We report a case in which effective and safe pain control was achieved without complications using burst-mode SCS in an elderly patient with PCP and well-established PHN in the thoracic region.
Case report : This study was approved by the Institutional Review Board of the Korea University Medical Center, Guro on February 11, 2019. The patient was an 80-year-old man who had a permanent cardiac pacemakers (PCP) implanted 3 months prior to admission because of complete atrioventricular block. He was diagnosed with acute HZ because he had a painful blister with a visual analog scale (VAS) score ≥9 on the second left thoracic dermatome. On day 180 of the rash, SCS was suggested to relieve the uncontrolled pain. Pacemaker sensitivity and possible interference between PCP and SCS were tested during the SCS trial in the operating room. No interference between the PCP and SCS was observed during the SCS trial in the operating and recovery rooms. The patients reported pain reduction more significantly in burst mode SCS than in tonic mode SCS and opted for permanent burst mode SCS implantation. 1 month after insertion of the SCS, VAS score was consistent at 3, and the patient reduced the dose of narcotic analgesic. At follow-up 6 months after SCS insertion, the patient showed pain relief of approximately 50%.
Conclusion : This case report indicates that burst mode SCS can be an effective and safe treatment for patients with intractable PHN with PCPs. Thorough monitoring to detect the interference between the two devices is a prerequisite for the simultaneous and safe use of burst-mode SCS and PCP.
Reference :
1. Sim, W.; Choi, J.; Han, K.; Kim, Y. Treatment of Herpes Zoster and Postherpetic Neuralgia. Korean J. Pain 2008, 21, 93-105.
2. Dworkin, R.; Gnann, J.; Oaklander, A.; Raja, S.; Schmader, K.; Whitley, R. Diagnosis and Assessment of Pain Associated with Herpes Zoster and Postherpetic Neuralgia. J. Pain 2008, 9, S37-S44.
