Spinal cord stimulation for treatment of the pain associated with hereditary multiple osteochondromas.

Journal of Pain Research Dovepress open access to scientific and medical research C a s e R e p o rt Open Access Full Text Article Spinal cord stimulation for treatment of the pain associated with hereditary multiple osteochondromas This article was published in the following Dove Press journal: Journal of Pain Research 18 August 2015 Number of times this article has been viewed Ravi G Mirpuri 1 Jereme Brammeier 2 Hamilton Chen 2 Frank PK Hsu 1,3 Vi K Chiu 4 Eric Y Chang 1,2,5 Department of Physical Medicine and Rehabilitaiton, 2 Department of Anesthesiology and Perioperative Care, 3 Department of Neurological Surgery, 4 Department of Medicine, Reeve-Irvine Research Center for Spinal Cord Injury, University of California Irvine, Irvine, CA, USA Objective: Hereditary multiple osteochondromas (HMO) usually presents with neoplastic lesions throughout the skeletal system. These lesions frequently cause chronic pain and are conventionally treated with surgical resection and medication. In cases where conventional treatments have failed, spinal cord stimulation (SCS) could be considered as a potential option for pain relief. The objective of this case was to determine if SCS may have a role in treating pain secondary to neoplastic lesions from HMO. Case presentation: We report a 65-year-old female who previously received both surgical and pharmacological interventions for treating HMO neoplastic pain in the lumbar, pelvis, femur, and tibial regions. These interventions either failed to offer significant pain relief or caused excessive lethargy. A SCS trial was then offered with a dual 16-contact lead trial leading to 70%–80% improvement in pain from baseline and 85% reduction in oxycodone IR intake. This was followed by permanent implantation of two 2×8 contact paddle leads (T7–T8 and T9–T10 interspaces). After 8-week follow-up, settings were further optimized resulting in an additional 30% improvement in pain compared to last visit. At 6-month follow-up, the patient reported continued pain relief. Conclusion: This case demonstrates the first successful use of SCS to treat both HMO and non- malignant neoplastic-related pain. The patient reported pain improvement from baseline, reduced pain medication requirements, and subjective improvement in quality of life. Additionally, this case demonstrates the potential advantage of trialing multiple painful areas with a 16-contact lead in order to avoid multiple trials and placement. Keywords: Exostoses, bone neoplasms/pathology, hereditary exostoses/multiple, back pain/ therapy, pain management, spinal cord stimulation, treatment outcome, chronic pain, case reports Introduction Correspondence: Eric Y Chang Department of Physical Medicine and Rehabilitation, University of California Irvine, Gillespie Building Rm 3226A, 837 Health Science Road, Irvine, CA 92697- 1050, USA Tel +1 949 824 7222 Email changey1@uci.edu Hereditary multiple osteochondromas (HMO) is primarily an autosomal dominant disorder where benign osteochondromas form throughout the skeletal system. Common locations of formation are the metaphyses of long bones including the femur, tibia, and humerus. 1 This rare disorder has a prevalence of one in 50,000 with nearly all patients diagnosed before the age of 12 years. 2,3 Treatment is recommended when lesions become symptomatic with manifestations of pain, peripheral nerve impinge- ment, or debilitating bone deformities. 4 In most cases, surgical excision is the main treatment although recurrence rates are high, especially with incomplete resection or in rare cases of malignant transformation. 5,6 Although historically HMO is never treated, spinal cord stimulation (SCS) has been shown to provide symptomatic pain relief for refractory anginal pain, ischemic submit your manuscript | www.dovepress.com Journal of Pain Research 2015:8 557–560 Dovepress © 2015 Mirpuri et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/JPR.S86790