Importance of Spinal Cord Stimulation Therapy for Concomitant Phantom Limb Pain and Critical Limb Ischemia
In about 80% of patients who have undergone amputation, they experience severe phantom limb pain (PLP). The severity of pain exists in about 5–10% patients, although in many both the frequency and intensity of pain attacks diminish with the course of time.
It is possible that the peripheral and central nervous system are responsible in the occurrence and persistence of pain in the amputated lower limb. Classically, the treatment for PLP can be diversified into pharmacologic, surgical, anesthetic and psychological modalities. For a new treatment option for this condition, the spinal cord stimulation (SCS) cannot be treated as a new treatment measure. In the current literature, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been evoked.
The main goal of this article brings forward the likelihood to apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after non-fulfillment of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. The pain decreased by 50% on both the right and left side in all the patients after the SCS implantation and test stimulation. Decrease of opioids analgesics use was at least 50%, the transcutaneous oxygen (TcPO2) increase >75% and pain maintained to within 20–30/100 mm on visual analog scale were the key manifestations for permanent SCS therapy after 1 week of test stimulation.