CHRONIC VISCERAL PAIN TREATED WITH 10 khz SPINAL CORD STIMULATION: A CASE REPORT

L. Sandroni, M. Parolini | Pain Therapy Center, Complex Operating Unit (UOC), AUSL Toscana South East, Arezzo

INTRODUCTION
Visceral pain originates from thoracic, abdominal, or pelvic organs. It is typically diffuse, poorly localized, and described as cramping, pressure-like, or deep aching¹. Pathophysiology involves activation of unmyelinated C fibers due to mechanical distension, ischemia, or inflammation. Signals are transmitted via autonomic pathways to the CNS. A key feature is spinal convergence of visceral and somatic afferents, resulting in referred pain. Autonomic symptoms (e.g., nausea, sweating, tachycardia) and strong emotional components are also common, due to limbic system involvement. Diagnosis and management are often complex, requiring multimodal approaches.
CASE PRESENTATION
A male patient was referred for chronic right hypochondrial pain. History included benign prostatic hyperplasia, right radiculopathy, and left coxalgia, previously treated with infiltrations. The patient reported 10 kg weight loss due to pain. Ongoing medications included buprenorphine patch (52 mcg/h), oxycodone/naloxone (20 mg TID), pregabalin (75 mg BID), duloxetine (30 mg daily), and vaporized high-THC cannabis (four times/day). Pain began eight years earlier, described as constant stabbing in the right hypochondrium, alleviated by walking and worsened by sitting. Flares improved with intramuscular diclofenac. MRI revealed right renal inflammatory changes; PET showed somatostatin receptor uptake in the duodenopancreatic area. Lumbar MRI was normal. Given the diagnosis of drug-resistant chronic visceral pain, the patient underwent two-stage high-frequency spinal cord stimulator (SCS 10 kHz) implantation between May and June 2024, without complications. Leads were placed between T3–T6 in a right median-paramedian position.
RESULTS
At 1, 3, 6, and 12-month follow-ups, the patient reported substantial pain relief (NRS reduced from 9/10 to 2/10), improved quality of life (EQ-5D-5L from 0,130 to 0,758), and decreased use of analgesics. The patient is currently receiving transdermal buprenorphine 20 mcg/h and duloxetine 30 mg; pregabalin, oxycodone/paracetamol, diclofenac and cannabinoids have been discontinued. Device function was stable and well-managed.
CONCLUSIONS
This case supports the efficacy of high-frequency (10 kHz) SCS in treating chronic, drug-resistant visceral pain. Results align with existing literature demonstrating benefits in reducing pain, enhancing quality of life, and minimizing opioid use². High-frequency SCS represents a valuable tool in the multidisciplinary management of complex abdominal pain, particularly in patients with mixed neuropathic-visceral features³.