IngentaConnect Pain relief and improvement of nutritional skin blood flow under ...

Abstract:

Background: Spinal cord stimulation has been suggested to improve microcirculatory blood flow. We studied the effects of spinal cord stimulation on the microcirculatory blood flow in patients with ischemic rest pain due to inoperable peripheral vascular disease.

Patients and methods: Only patients with severe ischemic pain were considered for implantation of the stimulation system. Skin microcirculation was studied by means of videocapillaromicroscopy and transcutaneous oxygen measurement in 47 patients. Intra-arterial angiography showed occluded crural vessels unsuitable for redo-surgery in all patients.

Results: Significant pain relief was obtained in 68.2% of the patients and major amputation had to be performed in 14 patients (29.8%). Microcirculatory parameters did not change under stimulation. Microcirculatory parameters increased significantly in patients with limb survival: the number of perfused capillaries increased under stimulation from 12 to 20/mm² (P < 0.02), red blood cell velocity increased from 0.11 to 0.29 mm/s (P < 0.02), TcPO2 from 25.3 to 43.8 (P < 0.03) and the regional perfusion index from 0.46 to 0.88 (P < 0.035). Microcirculatory parameters were significantly higher in responders than in non-responders.

Conclusions: Spinal cord stimulation has good pain-relieving effects in patients with inoperable peripheral vascular disease. Microcirculatory skin blood flow was significantly better in the patients with pain relief and ulcer healing, suggesting a relation between the clinical effects and the improved microcirculatory blood flow. Spinal cord stimulation can be considered as an effective concept in the treatment of ischemic pain in inoperable patients. Appropriate selection criteria should be worked out to identify potential responders to SCS.

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Pain relief and improvement of nutritional skin blood flow under spinal cord stimulation in patients with limb-threatening ischemia