A case of intractable central post-stroke pain successfully treated with cervical epidural spinal cord stimulation

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Central post-stroke pain (CPSP) is often difficult to treat. We report a case of intractable pain of the extremity and orbit due to the vascular lesion of the thalamus which was successfully treated by cervical epidural spinal cord stimulation (SCS).A woman in her sixties had been surgically treated for right intracerebral hemorrhage 4 years previously. Three month thereafter, she developed left hemiparesis. Three weeks afterthat, she developed right hemiparesis, which was followed by intractable burning pain and allodynia of the right arm, right leg, and right orbit. Computed tomography in December 1998 demonstrated a low density area at the right temporal lobe and putamen. Regional cerebral blood flow using single photon emission computed tomography on November 1998 demonstrated a low blood flow area in the bilateral thalamus.On September, 2002, she was referred to our clinic for severe pain with a visual analog scale (VAS) of 100/100. Result of drug challenge tests with lidocaine, thiamylal, morphin and ketamine, showed that only ketamine could alleviate her pain. Because of nausea, she refused intravenous ketamine treatment. SCS at the level of the cervical epidural space was tried, which successfully decreased her pain to a VAS range of 20/100-30/100.
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