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Title: Tens As A Rescue Neurostimulation Modality For Refractory Neuropathic Pain In Financially Constrained Patients.
e-poster Number: INSIM75
Category: Pain
Author Name: Chetna Shamshery
Institute: SGPGIMS
Co-Author Name: Anjali Singh, Ritika Agrawal
Abstract :
Spinal cord stimulation (SCS) is a proven indication for management of refractory neuropathic pain in cases of FBSS, CRPS and PHN. SCS incurs heavy finances, hence we report using TENS in 2 cases of refractory neuropathic pain who had financial constraints and failed to respond for long term to multiple anti-neuropathic medications and repeated interventions. TENS was tried because its mechanism of action overlaps with SCS and etiology of both cases involved peripheral neuropathy.
1st case: 60yr male developed CRPS in left forearm due to glass cut injury 2 years back. Nerve conduction velocity revealed axonal degeneration of median and ulnar nerve and bone scan reported increased tracer uptake during 3rd phase in small joints of hands. Nerve repair surgery, physiotherapy, cognitive behavioural therapy, trigger point neutralization, stellate and thoracic (T2T3) sympatholysis and carpal tunnel injection did not give sustained relief.
2nd case: 50yr old female with history of herpes zoster in T5-6 dermatome 15yrs back, now complains of sensitization from T3-T8 with severe burning and allodynia. Interventions comprising epidural, paravertebral, intercostal diagnostic, dorsal root ganglion radiofrequency etc gave transient relief of few days.
Both cases received trial of TENS via portable device at amplitude of 30 and 60mA respectively, frequency 20Hz and pulse width 200 µsec resulting in pain relief, following which they took TENS therapy at home for 6mths and 1 year respectively and till date report significant relief.
TENS may be tried as an affordable modality before more invasive and costlier neuromodulatory interventions are sort.
