Spinal Cord Stimulation for Intractable Pain Following Limb Amputation

Objective: Spinal cord stimulation (SCS) by high‐frequency electrical pulses has been used since the early 1970s for relief of chronic intractable pain following limb amputation. The long‐term effectiveness of SCS for amputation‐related pain with ongoing after‐care is reviewed by assessment of all such cases managed over 20 years in the Neurostimulator Clinic at the Royal London Hospital. Materials and Methods: Twelve amputation‐related pain patients had quadripolar paddle electrodes (Resume; Medtronic Inc., Minneapolis, MN, USA) inserted epidurally by laminectomy over the thoracic or cervical dorsal spinal cord and connected to remotely controlled subcutaneously implanted stimulators (Itrel2, Itrel3, Synergy; Medtronic). Results: Two of 12 patients had unsuccessful stimulation, one despite repeated electrode revisions. Two were subsequently lost to follow‐up, one had delayed spontaneous resolution of phantom limb pain, one had a technical fault, and one had gradually waning benefit over 19 years. In the remaining five patients having ongoing follow‐up, self‐reported initial and final magnitudes of pain relief were unchanged, with a mean (SD) of 66% (18.2%). Benefits calculated from local and general visual analogue pain scores were similarly unchanged (initial local 48.8% [18.7%]; final local 50.0% [17.6%]; initial general 60.8% [10.9%]; final general 57.9% [12.3%]). Continued successful stimulation often required frequent changes of stimulating electrode contacts. Revision procedures for technical problems or pain at the battery site were universally successful. Conclusions: Successful SCS in some patients with amputation‐related pain otherwise resistant to treatment indicates that the procedure merits continued use with further efforts to refine technique.