What are the risks and benefits of spinal cord stimulators and intrathecal pumps?

Abstract

A 56-year-old male is evaluated during a scheduled follow-up appointment in the pain clinic for back and radicular pain that persists after an L3-5 laminectomy 2 years ago. His analgesic regimen is oxycodone controlled release, 60 mg BID (twice a day), with oxycodone immediate release, 15 mg TID (3 times a day), as needed, along with gabapentin, amitriptyline, and lidocaine patches. The patient is not satisfied with this regimen, because his pain prevents him from returning to work. He asks to have the dose of controlled release oxycodone increased because its efficacy has decreased over time. Lumbar epidural steroid injections and medial branch nerve blocks have not helped. Physical therapy offers only minimal pain relief. The patient consults with a psychiatrist for mild depression. After a recent consultation, he was offered a revision procedure by an orthopedic spine surgeon, but the patient is reluctant to accept, given the poor outcome from the first surgical intervention. The resident evaluating the patient is unsure of the next step: increase opioids? Repeat surgery? Other treatment options?.