New parameter adjustment with spinal cord stimulation for postherpetic neuralgia treatment: A case report and literature review

摘要

Posterpetic neuralgia (PHN), a common and often severe painful condition, is a kind of refractory neuropathic pain (NP). Although the clinical treatment of PHN including pregabalin, nerve block and pulsed radiofrequency have been devoted with adequate and reasonable efforts, a proportion of people with PHN fail to obtain pain relief. Spinal cord stimulation (SCS) represents an adjustable and nondestructive procedure that considered electrical stimulation as the key mechanism for NP relief and offers an alternative treatment for PHN. SCS parameters, including amplitude, pulse width and frequency, influence the nervous system and the delivery of stimulation charge. Newly proposed stimulation methods such as high-frequency SCS and burst SCS, may offer alternative treatment for NP. In this paper, we reported a case of major pain successfully treated with SCS by adjusting the stimulation parameter and the electrode position using new stimulation method. The patient suffered from severe persistent PHN in the right upper limb area. The temporary SCS electrode was placed in the dorsal root entry zone (DREZ) area with a standard generator. Initially, we programmed the parameters at 360?Hz, 140?μs, and 1.5?V. After multiple setting adjustments with inadequate pain relief, the patient was finally programmed at 40?Hz, 120?μs, and 0.5?V. This parameter setting provided optimal pain alleviation and increased the quality of the patient's life. The visual analogue scale and Hamilton anxiety scores were decreased significantly. These scores showed no significant change during the six-month follow-up. SCS combined with dorsal root entry zone at relatively high frequency and low voltage offers a new method to treat PHN patients.