Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Postmastectomy pain syndrome (PMPS) is a chronic pain syndrome that can be refractory to treatment by pain specialists. Spinal cord stimulation is a technique that has been approved for neuropathic pain and shown promise as a modality for targeted treatment. In this study, we report the outcomes of spinal cord stimulation in patients with refractory PMPS.
CASE REPORT: A retrospective chart review was performed at The University of Texas MD Anderson Cancer Center to identify patients who underwent spinal cord stimulation during a 3-year period. Relevant outcomes for efficacy and safety were evaluated. The protocol was reviewed and approved by The University of Texas MD Anderson Cancer Center Institutional Review Board.
Seven patients with refractory PMPS were treated with spinal cord stimulation at our institution. All patients initially underwent trial spinal cord stimulation, with a mean preoperative Numeric Rating Scale (0-10) (NRS-11) score of 8.29 ± 1.70. Six of 7 (85.7%) patients reported a successful trial stimulation (> 50% pain reduction); however, only 5 received permanent implantation. Following implantation, the reported one-month postoperative NRS-11 score was 4.20 ± 1.79. The mean change in the pain score between pre- and postoperative intervention was 4.40 ± 1.34 (Cohen’s d = 3.28, P = .002). The mean decrease in the morphine equivalent daily dose (MEDD) following implantation was 55.80 (SD 82.21, Cohen’s d = 0.68, P = .125).
CONCLUSION: Spinal cord stimulation may be an effective therapy for patients experiencing chronic PMPS and should be considered in medically refractory cases. Future prospective studies are warranted to confirm the positive outcomes we demonstrated pertaining to pain scores and opioid medication changes.
KEY WORDS: Cancer pain, postmastectomy pain syndrome, neuromodulation, opioids