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Chronic subdural cortical stimulation for phantom limb pain: report of a series of two cases

  • Case Report - Functional Neurosurgery - Pain
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Abstract

Phantom limb pain is a complex, incompletely understood pain syndrome that is characterized by chronic painful paresthesias in a previous amputated body part. Limited treatment modalities exist that provide meaningful relief, including pharmacological treatments and spinal cord stimulation that are rarely successful for refractory cases. Here, we describe our two-patient cohort with recalcitrant upper extremity phantom limb pain treated with chronic subdural cortical stimulation. The patient with evidence of cortical reorganization and almost 60 years of debilitating phantom limb pain experienced sustained analgesic relief at a follow-up period of 6 months. The second patient became tolerant to the stimulation and his pain returned to baseline at a 1-month follow-up. Our unique case series report adds to the growing body of literature suggesting critical appraisal before widespread implementation of cortical stimulation for phantom limb pain can be considered.

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Abbreviations

CT:

Computed tomography

DBS:

Deep brain stimulation

DREZ:

Dorsal root entry zone

GABA:

Gamma-aminobutyric acid

ICU:

Intensive care unit

IASP:

International Association for the Study of Pain

MRI:

Magnetic resonance imaging

PNS:

Peripheral nerve stimulation

PLP:

Phantom limb pain

rTMS:

Repetitive transcranial magnetic stimulation

SCS:

Spinal cord stimulation

VNRS:

Verbal numerical rating scale

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Acknowledgements

The authors would like to thank Dr. Richard Sharp for advising on the biomedical ethics topics pertaining to the off-label use of FDA approved devices.

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Authors and Affiliations

  1. Departments of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Mykhaylo D. Krushelnytskyy, Lucas P. Carlstrom, Seungleal (Brian) Paek & Kendall H. Lee

  2. Departments of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Bryan T. Klassen, Brian N. Lundstrom, Igor A. Lavrov, Squire M. Stead & Paola Sandroni

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  1. Mykhaylo D. Krushelnytskyy
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  2. Lucas P. Carlstrom
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Correspondence to Kendall H. Lee.

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Conflict of interest

Dr. Kendal H Lee served as a consultant to Medtronic Inc. in the past year. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript

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Informed consent, including the discussion of off-label use of FDA approved devices, was obtained from all individual participants included in the study.

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Krushelnytskyy, M.D., Carlstrom, L.P., Klassen, B.T. et al. Chronic subdural cortical stimulation for phantom limb pain: report of a series of two cases. Acta Neurochir 161, 925–934 (2019). https://doi.org/10.1007/s00701-019-03828-1

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