PDF(Pubmed)
Abstract：
BACKGROUND: Central neuropathic pain after foramen magnum decompression (FMD) for Chiari malformation type 1 (CM-1) with syringomyelia can be residual and refractory. Here we present a case of refractory central neuropathic pain after FMD in a CM-1 patient with syringomyelia who achieved improvements in pain following spinal cord stimulation (SCS) using fast-acting sub-perception therapy (FAST™).
METHODS: A 76-year-old woman presented with a history of several years of bilateral upper extremity and chest-back pain. CM-1 and syringomyelia were diagnosed. The pain proved drug resistant, so FMD was performed for pain relief. After FMD, magnetic resonance imaging showed shrinkage of the syrinx. Pain was relieved, but bilateral finger, upper arm and thoracic back pain flared-up 10 months later. Due to pharmacotherapy resistance, SCS was planned for the purpose of improving pain. A percutaneous trial of SCS showed no improvement of pain with conventional SCS alone or in combination with Contour™, but the combination of FAST™ and Contour™ did improve pain. Three years after FMD, percutaneous leads and an implantable pulse generator were implanted. The program was set to FAST™ and Contour™. After implantation, pain as assessed using the McGill Pain Questionnaire and visual analog scale was relieved even after reducing dosages of analgesic. No adverse events were encountered.
CONCLUSIONS: Percutaneously implanted SCS using FAST™ may be effective for refractory pain after FMD for CM-1 with syringomyelia.
METHODS: A 76-year-old woman presented with a history of several years of bilateral upper extremity and chest-back pain. CM-1 and syringomyelia were diagnosed. The pain proved drug resistant, so FMD was performed for pain relief. After FMD, magnetic resonance imaging showed shrinkage of the syrinx. Pain was relieved, but bilateral finger, upper arm and thoracic back pain flared-up 10 months later. Due to pharmacotherapy resistance, SCS was planned for the purpose of improving pain. A percutaneous trial of SCS showed no improvement of pain with conventional SCS alone or in combination with Contour™, but the combination of FAST™ and Contour™ did improve pain. Three years after FMD, percutaneous leads and an implantable pulse generator were implanted. The program was set to FAST™ and Contour™. After implantation, pain as assessed using the McGill Pain Questionnaire and visual analog scale was relieved even after reducing dosages of analgesic. No adverse events were encountered.
CONCLUSIONS: Percutaneously implanted SCS using FAST™ may be effective for refractory pain after FMD for CM-1 with syringomyelia.
摘要：
背景：对于Chiari畸形1型（CM-1）伴脊髓空洞症，枕骨大孔减压（FMD）后的中枢神经源性疼痛可能是残余和难治性的。在这里，我们介绍了一例患有脊髓空洞症的CM-1患者FMD后难治性中枢神经性疼痛的病例，该患者使用速效亚感知疗法（FAST™）实现了脊髓刺激（SCS）后疼痛的改善。
方法：一名76岁女性，有多年的双侧上肢和胸背部疼痛病史。诊断为CM-1和脊髓空洞症。疼痛被证明是耐药的，所以FMD是为了缓解疼痛。口蹄疫之后,磁共振成像显示syrinx收缩。疼痛缓解了,但是双侧手指,10个月后上臂和胸背部疼痛发作。由于药物治疗抵抗，SCS计划用于改善疼痛。一项经皮SCS试验显示，单独使用常规SCS或与Contour™联合使用对疼痛无改善，但FAST™和Contour™的组合确实改善了疼痛。口蹄疫三年后，植入经皮导线和植入式脉冲发生器.程序设置为FAST™和Contour™。植入后,使用McGill疼痛问卷和视觉模拟量表评估的疼痛即使在减少镇痛药剂量后也得以缓解。没有发生不良事件。
结论：使用FAST™经皮植入SCS可能对CM-1伴脊髓空洞症的FMD后难治性疼痛有效。
方法：一名76岁女性，有多年的双侧上肢和胸背部疼痛病史。诊断为CM-1和脊髓空洞症。疼痛被证明是耐药的，所以FMD是为了缓解疼痛。口蹄疫之后,磁共振成像显示syrinx收缩。疼痛缓解了,但是双侧手指,10个月后上臂和胸背部疼痛发作。由于药物治疗抵抗，SCS计划用于改善疼痛。一项经皮SCS试验显示，单独使用常规SCS或与Contour™联合使用对疼痛无改善，但FAST™和Contour™的组合确实改善了疼痛。口蹄疫三年后，植入经皮导线和植入式脉冲发生器.程序设置为FAST™和Contour™。植入后,使用McGill疼痛问卷和视觉模拟量表评估的疼痛即使在减少镇痛药剂量后也得以缓解。没有发生不良事件。
结论：使用FAST™经皮植入SCS可能对CM-1伴脊髓空洞症的FMD后难治性疼痛有效。
