Resolution of symptoms in idiopathic thalamic pain syndrome after implantation of a cervical and thoracic percutaneous spinal cord stimulator

Background: Thalamic pain syndrome is classically described as chronic pain after an infarct of the thalamus. It leads to a decrease in the quality of life, especially for patients with inadequate treatment. Supportive imaging, such as a thalamic lesion or infarct, is widely accepted as necessary to diagnose this condition. Case Description: In this case report, we describe the case of a patient who developed allodynia and hyperesthesia with a hemibody distribution characteristic of thalamic pain syndrome, despite having no clear inciting event or identifiable thalamic lesion. This patient was successfully treated with cervical and thoracic spinal cord stimulation (SCS). Conclusion: We suggest that this patient may have presented with a non-lesional thalamic pain syndrome, supported by the classic hemibody allodynia and hyperesthesia and the response to SCS. Further, we demonstrate that SCS was an effective method to control this central pain disorder.

Treatment of central and spinal cord neuropathic pain with Scrambler Therapy.

127 Background: Central pain caused by spinal cord or brain injury tends to be severe and refractory despite aggressive treatment, such as in thalamic pain syndrome, neuromyelitis optica spectrum disorder (NMOSD) and other forms of transverse myelitis, and spinal cord gliomas. Methods: We reviewed our experience with treatment of these relatively rare maladies with Scrambler Therapy, a noninvasive form of neuromodulation. Results: One transverse myelitis patient got substantial relief lasting months (Mealy M, Int J MS Care. 201), leading to the NMOSD trial. In a small, sham-controlled randomized trial, NMOSD patient pain scores were reduced in the ST arm from 5 to 1.5 at 30 days, P< 0.01, while the sham treatment gave no relief. (Neurology, resubmitted) Of three patients with pain due to thalamic strokes, surgery and/or radiation, treatment gave over 50% relief long-term in 2 of 3 (D’Amato S, A A Pract. 2018). In the one spinal cord glioma patient, pain in her index finger was reduced from 8-10/10 to 1-2/10 and treatment is ongoing. All successfully treated patients reported marked relief of allodynia and hyperalgesia, in addition to pain relief as reported previously (Marineo G, JPSM 2012). Conclusions: Scrambler therapy is a promising treatment modality for patients with these individually rare but collectively common forms of central pain. It has allowed return to more normal function in most patients, with reductions in pain medication use. Pictures of electrode placement and treatment plans will be shown, allowing others to do this safe and often effective treatment. Clinical trial information: NCT03452176.