Presented at the 2012 AAPM Annual Meeting « Back

Celiac Plexus Block for Abdominal Pain Is a Good Predictor of Spinal Cord Stimulation Success

Neil Thakkar, DO, nthakkar33@gmail.com¹, Hammam Akbik, MD², Harsh Sachdeva, MD³, (1) University of Cincinnati, Cincinnati, Ohio, (2) Pain Medicine, Fairfield, Ohio, (3) University of Cincinnati, West Chester, Ohio

Introduction: Current literature shows spinal cord stimulation (SCS) reduces pain scores and improves function in patients with chronic visceral abdominal pain (CVAP).1 However, no consensus exists for selection of patients with CVAP for SCS.2 Celiac plexus blocks (CPB) is an acceptable treatment for upper abdominal pain.3 We report two case studies of patients who underwent CPBs for CVAP followed by SCS. Methods: Both patients were treated at the UC Health Pain Management Center in Cincinnati, OH. Both were diagnosed with CVAP and failed conservative medical management (CMM). They underwent CPBs under CT guidance followed by SCS trials and implantation. Results: Case 1: Ms. P., a 48-year-old female with chronic pancreatitis, had failed CMM with high doses of Methadone and Hydromorphone. She underwent CPB (100% pain relief), followed by a SCS trial (90% pain relief). Permanent implantation achieved 100% pain relief. Case 2: Ms. S., a 43-year-old female with CVAP in her epigastric region brought on by pancreatitis, had failed CMM with a Fentanyl patch. After three CPBs (60-75% pain relief), a SCS trial was placed (90% pain relief). Permanent implantation achieved excellent pain relief. Conclusions: In these cases, SCS successfully relieved pain from CVAP. Both patients underwent CPB with positive results before selection for neuromodulation. Presently, there is no consensus regarding which patients with CVAP will benefit from SCS. 2 Based on our results, we advocate patients with CVAP alleviated by CPBs are ideal candidates for SCS trials. References: 1)Kapural, L. et Al. Spinal Cord Stimulation for Chronic Visceral Abdominal Pain. Pain Medicine. 2010 Mar;11(3):347-55. 2)Kapural, L. et Al. Technical Aspects of Spinal Cord Stimulation for Managing Chronic Visceral Abdominal Pain: The Results from the National Survey. Pain Medicine. 2010. May;11(5):685-91. 3)Caroll, L. Celiac Plexus Block for Visceral Pain. Current Pain and Headache Reports. 2006. Feb;10(1):20-5.

Funding: None