![]() The present single-center, retrospective consecutive case study is intended to determine the effectiveness of SCS in improving symptoms in patients with chronic nausea, vomiting, and refractory abdominal pain. In another study SCS improved pain scores and decreased opioid requirements in a cohort that included patients with gastroparesis and abdominal pain. A subgroup in that patient cohort had gastroparesis and experienced a significant decrease in pain. Twenty-four patients reported at least 50% pain reduction, confirming that the splanchnic nerves, which are derived from the T5-12 segments, are an important stimulation target. In that study, low-frequency SCS was delivered at the T4, T5, or T6 vertebral body levels with 1–3 leads placed in the midline position. SCS as a treatment for chronic visceral pain with optimal lead placement for more consistent visceral pain relief was published in 2010. These results suggest that a SCS-induced increase in GI motility might be attributed to the inhibition of sympathetic afferent and/or efferent activity with subsequent modulation of sympathovagal balance. SCS decreases sympathetic activity by providing sympathovagal balance as measured by spectral analysis of heart rate variability. Gastrointestinal (GI) motility is generally enhanced with the augmentation of vagal efferent nerve activity and inhibited by efferent sympathetic activity. In contrast, the parasympathetic vagal nerve afferents are carried in anterior and posterior trunks and are not amenable to SCS. The sympathetic nerves carry nociceptive information from the viscera to spinal nerve roots, which makes sympathetic pathways an appropriate target for SCS. Ī relationship between conventional spinal cord stimulation (SCS) and the enteric nervous system in abating visceral pain, nausea, and vomiting has been demonstrated. Because of the well-established gastrointestinal side effects of narcotic analgesics, management of this pain adds an additional layer of clinical complexity to an already difficult predicament. Refractory abdominal pain in the setting of chronic nausea and vomiting is reported in gastroparesis and is similarly impactful with over one-third of patients reporting severe abdominal pain. Despite the major quality of life impact of these symptoms, treatment of the symptoms can be difficult and the identification of the underlying causes may be challenging. Additionally, nausea is frequently accompanied by vomiting and the combination of nausea and vomiting have marked deleterious effects on quality of life and are predictors of healthcare utilization. There are many causes of nausea, a subjective symptom often accompanied by autonomic features, and therefore the diagnostic and therapeutic options are diverse. SCS may be an effective therapy for long-term treatment of symptoms for those patients afflicted with chronic nausea, vomiting, and refractory abdominal pain. ![]() Opioid use decreased from 57.7 mg MSO4 equivalents to 24.3 mg at 6 months and to 28.0 mg at the latest patient visit (both p < 0.05). Abdominal pain scores improved from 8.7 to 3.0 and 3.2 at 6 months and the most recent visit, respectively (both p < 0.001). Days of nausea decreased from 26.3 days/month at baseline to 12.8 and 11.7 days/month at 6 months and at the most recent visit, respectively. At baseline, 20 of the 23 patients (87.0%) reported daily nausea, but at 6 months and the most recent follow-up, only 8 (34.8%) and 7 (30.4%) patients, respectively, had daily nausea ( p < 0.001). ![]() Patients were then followed for 41 (22–62) months. Twenty-three patients (88.5%) reported > 50% pain relief during the temporary SCS trial and then underwent permanent implantation. ResultsĢ6 patients underwent SCS trial, with an average age of 48 years. Retrospective chart review of 26 consecutive patients who underwent SCS trial for a primary diagnosis of nausea, vomiting and refractory abdominal pain. We aimed to determine the effect of SCS in patients with chronic nausea, vomiting, and refractory abdominal pain. Spinal cord stimulation (SCS) may provide pain control, but scarce data are available regarding the effect of SCS on chronic nausea and vomiting. Patients with chronic nausea and vomiting often also have chronic abdominal pain. ![]()
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