<Case Report> Efficacy of Spinal cord stimulation therapy for post thoracotomy pain syndrome: a case report

[Abstract] Background: Spinal cord stimulation (SCS) therapy is effective for the treatment of neuropathic pain, but there are few reports that demonstrated the efficacy of SCS for patients with post-thoracotomy pain syndrome (PTPS) who had received thoracic nerve root blocks with pulsed radiofrequency (PRF) but had not gotten sufficient pain relief. Case presentation: The patient underwent resection of giant cell tumor in the right 6th rib in 2014. Due to right chest back pain after surgery, she received thoracic nerve root blocks with PRF several times at another institute. Although the pain was relieved for a couple of months after the block, she could not obtain permanent pain relief. She consulted our pain clinic in 2018. We prescribed 150 mg of pregabalin, 40 mg of duloxetine per day. We confirmed the efficacy of ultrasound-guided and fluoroscopy-assisted selective 6th thoracic nerve root block with PRF. Her pain relief continued for about 2 months. As she felt severe pain again, we administered PRF treatment and radiofrequency thermocoagulation (RFTC); however, she felt intractable pain again. Because her pain had neuropathic origin and was reactive to PRF, we decided to administer SCS therapy. She could feel the appropriate stimulated paresthesia for all regions of the pain, and her pain was also markedly reduced. As a result, we could reduce and finally discontinue her medications. Conclusions: We described effective SCS therapy for the patient with PTPS for several years, which was resistant to various treatments and was mainly caused by neuropathic pain.