Abstract
Introduction
Chronic post-sternotomy pain is common, persisting in about 30% of cases, despite the improvements in surgical techniques over the years. Its aetiology is not known but intercostal nerve damage may lead to the development of neuropathic pain1. This case study details the management of a patient with post-sternotomy pain treated successfully with 10kHz SCS.
Methods/Materials
A 39-year-old female with myasthenia gravis underwent a thymectomy in 2002. Post-operatively she developed chronic pain in the midline sternotomy wound. In 2007, the patient was referred to a pain clinic. Neuropathic trigger points were identified at 5 locations along the wound. The patient experienced short term relief with 6 monthly pulsed radio frequency (PRF). After several years the patient requested a more sustainable option. Spinal cord stimulation (SCS) was offered. 10kHz SCS was trialled for one week in September 2019, using 2 percutaneous leads covering C3 to T3. After successful trial, the patient was implanted with a permanent system.
Results
The pain was described as a ‘jolt’ phenomenon, ocurring hourly, with an intensity of 10/10 in the numerical rating scale (NRS). In addition the patient experienced a burning pain (NRS of 10/10) with allodynia to the back of both arms (Figure 1). At the end of trial, the patient reported a reduction in ‘jolts’ to a maximum of 3 times per day and the burning pain reduced to an NRS of 1/10.
These results have improved post-permanent implant, the patient reports a maximum of 3 days without any painful ‘jolt’ while the burning pain remains at an NRS of 1/10. The patient’s mood, sleep and function have improved which has contribuited to an improvement in the quality of life.
Discussion
The treatment of chronic post-sternotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects2.
10kHz SCS successfully managed this case of post-sternotomy pain. The patient reports reduced frequency of jolt like sternotomy pain and significant improvement in burning pain to the arms. They indicate the pain reduction has improved quality of life, mood, sleep and function.
The sustainable nature of 10kHz SCS offers long term efficacy without the need for repeated interventions.
Conclusions
10kHz SCS may be considered in patients experiencing chronic neuropathic poststernotomy pain.
References
1. Nicoline J. Van Leersum, Rutger L. Van Leersum, Harriette F. Verwey, Robert J. M. Klautz, Pain Symptoms Accompanying Chronic Poststernotomy Pain: A Pilot Study, Pain Medicine, Volume 11, Issue 11, November 2010, Pages 1628–1634, https://doi.org/10.1111/j.1526-4637.2010.00975.x
2. Kleiman AM, Sanders DT, Nemergut EC, Huffmyer JL, Chronic Poststernotomy Pain: Incidence, Risk Fators, Treatment, Prevention, and the Anesthesiologist's Role, Reg Anesth Pain Med 2017 Nov/Dec;42(6):698-708. doi: 10.1097/AAP.0000000000000663.
