International Journal of Physical Medicine & Rehabilitation
Open Access

Abstract

Transient Neuropathic Pain after the Insertion of Spinal Cord Stimulation Leads

Linqiu Zhou and Tom G Shahwan

Objectives: Spinal Cord Stimulation (SCS) therapy has been adopted as a standard treatment modality for various chronic pain conditions. Transient neuropathic pain is an unreported complication after lead insertion. Our objective was to determine the incidence of transient neuropathic pain in 221 consecutive patients after SCS placement.
Design and setting: This was a retrospective chart review conducted at Thomas Jefferson University Hospitals, from May 2005 to November 2011.
Patients: 221 patients were included: total 369 SCS procedures (trial: 213; implantation: 156); male: 135, female: 86; ages: 18 to 83 years (mean 46); cervical and upper thoracic spinal stimulation: 21, lumbar: 200 cases.
Methods: Incidence calculation of new onset pain after SCS leads insertion. Transient neuropathic pain is diagnosed with new onset pain in the lower limbs after SCS lead insertion.
Results: 5 (6 cases) of the 221 patients (369-procedures) experienced new pain in their lower extremity immediately after lead insertion. Each of these patients underwent lumbar SCS lead insertion; two after trial, two after implantation, and the fifth after both trial and implantation. Their symptoms involved pain at a localized area of one lower extremity. Thorough clinical examination was notable for heightened sensitivity to light touch and pinprick (allodynia) at the painful area, but no sensory or motor deficits. Four of 5 patients were treated with oral steroids for 7 days and followed closely until symptom resolution. Within 5 to 10 days, their pain resolved entirely without residual neurological deficits. One patient refused to take oral steroids. Her symptoms resolved after her SCS leads were removed.
Conclusion: Transient neuropathic pain after SCS lead insertion is an uncommon complication. Based on our data, the incidence is 1.62% (6/369). The clinical presentation is focal pain and allodynia without other neurological deficits. The cause of these symptoms is unclear. The management includes oral steroids, patient reassurance, and close follow-up.