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Kim, et al. (2001). Spinal cord stimulation for nonspecific limb pain versus neuropathic pain and spontaneous versus evoked pain

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  • Kim, et al. (2001). Spinal cord stimulation for nonspecific limb pain versus neuropathic pain and spontaneous versus evoked pain

    Kim, S. H., R. R. Tasker, et al. (2001). "Spinal cord stimulation for nonspecific limb pain versus neuropathic pain and spontaneous versus evoked pain." Neurosurgery 48(5): 1056-64; discussion 1064-5.
    OBJECTIVE: To compare the outcome of spinal cord stimulation (SCS) in patients with nonspecific limb pain versus patients with neuropathic pain syndromes and in patients with spontaneous versus evoked pain. METHODS: A retrospective review of 122 patients accepted for treatment with SCS between January 1990 and December 1998 was conducted. All patients first underwent a trial of SCS with a monopolar epidural electrode. Seventy-four patients had a successful trial and underwent permanent implantation of the monopolar electrode used for the trial (19 patients), or a quadripolar electrode (53 patients), or a Resume quadripolar electrode via laminotomy (2 patients). RESULTS: Of the 74 patients, 60.7% underwent implantation of a permanent device and were followed for an average of 3.9 years (range, 0.3-9 yr). Early failure (within 1 yr) occurred in 20.3% of patients, and late failure (after 1 yr) occurred in 33.8% of patients. Overall, 45.9% of patients were still receiving SCS at latest follow-up. Successful SCS (>50% reduction in pain for 1 yr) occurred in 83.3% of patients with nonspecific leg pain, 89.5% of patients with limb pain associated with root injury, and 73.9% of patients with nerve neuropathic pain. SCS was less effective for the control of allodynia or hyperpathia than for spontaneous pain associated with neuropathic pain syndromes. Third-party involvement did not influence outcome. There was a lesser incidence of surgical revisions when quadripolar leads were used than with monopolar electrodes. CONCLUSION: SCS is as effective for treating nonspecific limb pain as it is for treating neuropathic pain, including limb pain associated with root damage.
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