Spinal Cord Stimulation for the Treatment of Refractory Unilateral Limb Pain Syndromes

Background: Spinal cord stimulation (SCS) is an established therapy for chronic pain. Its success depends on vigorous patient selection and good follow-up. Methods: We reviewed 75 patients who had undergone SCS to establish their outcome. 67 of these patients had refractory unilateral limb pain syndrome (RULPS). Their case notes and operative log books were critically reviewed, and when appropriate, telephone interviews were performed (58 patients). Results: 87% of patients responded initially to SCS; at 6 months, the effect waned to 79%, and by 2 years, it improved to 84%. One third of the patients had no revisions, 40% had IPG replacements and the rest had revisions because of lead-related complications (5.3%), epidural complications (mainly fibrosis; 19%) or infections (2.7%). 56% of patients reduced their analgesia, 1.5% stopped taking any painkillers and 46.8% of those who were employed returned to work. Conclusion: We feel that SCS is an effective treatment in RULPS and its results depend upon vigorous patient selection and an adequate follow-up and maintenance program.