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Spinal Cord Stimulation

Spinal Cord Stimulation for the treatment of Chronic Renal Pain secondary to Uretero-Pelvic Junction Obstruction: Case Report. Spinal Cord Stimulation. Minimally invasive & reversible treatment option for chronic pain Neuropathic pain

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Spinal Cord Stimulation

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  1. Spinal Cord Stimulation for the treatment of Chronic Renal Pain secondary to Uretero-Pelvic Junction Obstruction: Case Report

  2. Spinal Cord Stimulation • Minimally invasive & reversible treatment option for chronic pain • Neuropathic pain • Few previous case reports in severe abdominal / pelvic visceral pain • No previous report in chronic renal pain

  3. Case: • 38 y/o Female with 15 year history of Rt sided flank pain & frequent UTIs • Clinical diagnosis of Congenital UPJO was made • No response to different interventions including stenting • Failed Conservative treatment • Minimal relief with opioids • Was finally referred to the pain clinic by Urology prior to undergoing robotic nephrectomy

  4. Pertinent Findings • Pain Level: 8/10 on VAS; 10/10 on flare-up episodes • Moderate pain on deep palpation of Abdomen and Rt flank region

  5. Limited treatment options • Sympathetic Plexus Block: • Celiac Block: No benefit • Superior Hypogastric block: Benefit but of limited duration • Spinal Cord Stimulation

  6. Spinal Cord Stimulation: Lead Placement A single octad lead with the tip at the level of the mid 7 vertebral body, slightly right on center.

  7. On follow-up • During 7-day Trial period: • 85% pain relief • Did not take any oral pain medications • Improved overall function, sleep & mood • Permanent implantation performed 4 wks later • 9 months later: only use OTC pain medications PRN

  8. Theories of Mechanism • Gate Control theory (mainly somatic pain) • Suppress nociceptive viscero-motor reflex • Increase in local visceral blood flow

  9. Conclusion • Patients with persistent chronic renal pain: • Conservative modalities should be utilized initially • More Interventional procedures as autonomic plexus block may be considered • If all failed: • SCS may provide a viable long-term option

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