gms | German Medical Science

Objective: Currently, inclusion criteria for permanent IPG insertion after trial stimulation in spinal cord stimulation are induced paresthesia in whole area of pain and greater than 50% of pain relief after series of stimulations during several days after operation. These parameters, however, are based on only subjective responses and there have not been objective measures to demonstrate its efficacy during these stimulations. Also, recently introduced high frequency and burst stimulation technique may not induce paresthesia which may cause more difficulty in determination of successful stimulation objectively. Author has used infrared thermography in these patients to validate its role in providing information whether trial stimulation correlates the symptomatic improvement thus may be used as a parameter for deciding permanent IPG insertion and predictive measurement for successful outcome.

Method: A total of twelve patients who underwent trial spinal cord stimulations with complete set of infrared thermographic examinations pre-, intra-, and postoperatively were included in this study. All patients had refractory pain that persisted more than 9 months from various causes. There were 6 male and 6 female patients with average age of 58 (range 48-72). The causes of chronic, intractable pain of these patients were persistent pain following spinal operations. All patients had pain of neuropathic type and had severe pain (greater than 7 of VAS) for average of 19.4 months (range 9-36 months). IR thermographic examination, using IRIS 5000, was done before and during trial “stimuation on” state. A single, 4 contract electrode was inserted percutaneously in 8 patients and a 8-contact dual type electrode in remaining 4 patients. Trials of test stimulation consisted of 60-150 Hz and 0.5-3.0 v.

Results: Good to excellent responses from trial stimulation (more than 75-100% of pain reduction with …

Conclusions: From these observations, the infrared thermography may provide useful and objective findings that correlate with patients’ improvement after trial spinal cord stimulation which may be used as an objective inclusion tip for the permanent IPG implantation and as a predictive finding for determining the successful results.