Spinal Cord Stimulation for Visceral Pain From Chronic Pancreatitis

Background and Objectives: Spinal cord stimulation (SCS) may reduce pain scores and improve function in patients with various chronic abdominal pain syndromes including chronic pancreatitis. Here described is a large clinical experience in SCS for severe chronic pancreatitis. Methods: SCS was trialed in 30 patients with chronic pancreatitis. SCS trials lasted 7-14 days (median 9 days). SCS lead tips were mostly positioned at the T5 (N = 10) or T6 (N = 10) vertebral level. Results: Twenty-four patients (80%) reported at least 50% pain relief on completion of the trial. Among these, pre-trial visual analog scale (VAS) pain scores averaged 8 +/- 1.6 (standard deviation) and opioid use averaged 165 +/- 120 mg morphine sulfate equivalents. During the trial, VAS pain scores decreased to 3.67 +/- 2 cm (p < 0.001, Mann-Whitney Rank Sum Test) and opioid use decreased to 105 +/- 101 mg morphine equivalent a day. Six patients failed the trial; one was lost to follow-up; in three patients after the implantation, the system had to be removed due to infection or lead migration; and 20 were followed for the whole year. For 20 patients followed for the whole year, VAS pain scores remained low (3.6 +/- 2 cm; p < 0.001) at one year, as did opioid use (48.6 +/- 58 mg morphine equivalents). Conclusions: SCS may be a useful therapeutic option for patients with severe visceral pain from chronic pancreatitis. Prospective trial is warranted.