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Published byIlene Ramsey Modified over 9 years ago
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Minimally invasive & reversible treatment option for chronic pain Neuropathic pain Few previous case reports in severe abdominal / pelvic visceral pain No previous report in chronic renal pain
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38 y/o Female with 15 year history of Rt sided flank pain & frequent UTIs Clinical diagnosis of Congenital UPJO was made No response to different interventions including stenting Failed Conservative treatment Minimal relief with opioids Was finally referred to the pain clinic by Urology prior to undergoing robotic nephrectomy
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Pain Level: 8/10 on VAS; 10/10 on flare-up episodes Moderate pain on deep palpation of Abdomen and Rt flank region
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Sympathetic Plexus Block: Celiac Block: No benefit Superior Hypogastric block: Benefit but of limited duration Spinal Cord Stimulation
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A single octad lead with the tip at the level of the mid 7 vertebral body, slightly right on center.
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During 7-day Trial period: 85% pain relief Did not take any oral pain medications Improved overall function, sleep & mood Permanent implantation performed 4 wks later 9 months later: only use OTC pain medications PRN
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Gate Control theory (mainly somatic pain) Suppress nociceptive viscero-motor reflex Increase in local visceral blood flow
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Patients with persistent chronic renal pain: Conservative modalities should be utilized initially More Interventional procedures as autonomic plexus block may be considered If all failed: SCS may provide a viable long-term option
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