This designation is critical and allows for a treatment plan to be crafted for each patient that is relevant to his or her complaint. An example of how this guides therapy selection is a patient with neuropathic leg pain after prior lumbar spine surgery. In such a patient anatomical procedures are not likely to benefit the patient; however, SCS is likely to be very efficacious.
Although the original report by Tsubokawa and associates 4 of MCS for chronic pain considered a group of seven patients who suffered from thalamic pain, this procedure has been used in patients presenting with varied facial pain syndromes in particular, without apparent regard to physiological presentation. Fontaine, Hamani, and Lozano 7 did an additional review and noted evidence for improvement of patients who experienced neuropathic pain on a variety of causal bases e.
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Patients in both studies were then followed long term with active open-label stimulation. One study examined 16 patients with limb or facial neuropathic pain who underwent MCS; 13 were crossed over in a double-blind fashion between active and no stimulation. However, in the 12 patients who completed the open-label study, the VAS and SIP scores were significantly reduced compared to baseline. On the other hand, a study by Velasco and associates trialed five patients with refractory complex regional pain syndrome CRPS and implanted four. Clinical signs, VAS, and McGill Pain Scale were monitored while the implanted MCS in each patient was either turned off or on for 30 days between days 30 and 60 and days 60 and 90 following implant in a double-blind fashion.
Table examines studies using MCS for the treatment of pain. Chapter Overview Chapter Synopsis: Many types of chronic pain can be improved by electrical stimulation of nerve tissue: in the periphery, at the spinal cord, and even in motor cortex. Important Points: MCS has been available for many years but has recently drawn interest as a viable therapy for the intractable pain patient. Many neurosurgeons use this therapy in an off-label fashion. A proper diagnosis is needed before selecting a patient for MCS. Facial and neuropathic pain appear to be the most likely types of disorders to respond to MCS.
Book chapters – MCSS
Patients should be treated with spinal cord or peripheral nerve stimulation before MCS if appropriate. Attention to detail is important to reduce complications in the patient undergoing MCS. More research is needed to determine the best use for this procedure. There is evidence supporting the use of this therapy in those patients who experience neuropathic pain but are anatomically or physiologically unable to obtain paresthetic overlap in their pain areas.
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