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. 2021 Jun 4;22(6):1305-1311.
doi: 10.1093/pm/pnab007.

Treatment Strategies for Generator Pocket Pain

Jonathan Bao  1 , Olga Khazen  1 , Zachary T Olmsted  1 , Guy Gechtman  1 , Miriam M Shao  1 , Marisa DiMarzio  1 , Gregory Topp  1 , Vishad V Sukul  2 , Michael D Staudt  2 , Julie G Pilitsis  1   2
Affiliations

Treatment Strategies for Generator Pocket Pain

Jonathan Bao et al. Pain Med. .

Abstract

Objective: Generator site pain is a relatively common phenomenon in patients undergoing spinal cord stimulation (SCS) that complicates management and effective pain relief. This pain may be managed conservatively, with repositioning of the battery and, in some cases, with explant. Here we explore our experience with management of generator site pain ("pocket pain") in a large single-center study.

Methods: All SCS permanent implants and implantable pulse generator (IPG) placements over 9 years were reviewed. Of 785 cases, we identified 43 patients with pocket pain (5.5%). Demographics and treatments of the pocket pain cohort were analyzed.

Results: The mean age (± SEM) of the pocket pain cohort was 46.86 ± 1.06, and there were 10/33 males/females. Females were overrepresented in pocket pain cohort (76.7%) when compared with the total SCS cohort (59.0%) (X2 = 5.93, P = 0.015). Diagnosis included failed back surgery syndrome (51.2%), complex regional pain syndrome (23.3%), and chronic neuropathic pain (25.5%). No patients improved with conservative therapy. All patients either went on to revision (n = 23) or explant (n = 20). Time from initial surgery to development of pocket pain was 7.5 months (range: 0.3-88) and from pocket pain to revision surgery was 4.5 months (range: 0.4-26). In addition, significantly more pocket pain patients (65.1%) had workers' compensation (WC) insurance compared with patients without pocket pain (24.9%) (X2 = 33.3, P < 0.001).

Conclusion: In our institutional experience, pocket pain was inadequately managed with conservative treatments. Being female and having SCS filed under WC increased risk of pocket pain. Future work will explore the nuances in device placement based on body shape and manual activity responsibilities.

Keywords: Chronic Pain; Complications; Failed Back Surgery Syndrome; Neuropathic Pain; Pocket Neuritis; Pocket Pain; Spinal Cord Stimulation.

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Figures

Figure 1
Figure 1
Unilateral Flank Placement of Pulse Generator. Anatomically-relevant diagram depicts IPG site in flank relative to rib cage (RC), iliac crest (IC) and the midline. Created with BioRender.com.
Figure 2
Figure 2
Generator Pocket Pain Management. OTC = over-the-counter. Injections refer to bupivacaine and triamcinolone pocket injections.
See this image and copyright information in PMC

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