Spinal stimulation helps some dialysis patients

For hemodialysis patients with very poor circulation in their legs, spinal cord stimulation reduces pain and increases quality of life, according to Italian researchers.

Investigator Dr. Mario Bonomini told Reuters Health that implantation of a spinal cord stimulation device in patients with end-stage renal disease and severely impaired blood flow, or ischemia, in their lower limbs "might delay the appearance of ... skin lesions and amputation."

"The timing of stimulator implantation appears of critical importance for clinical outcome," he added, "since no major benefits were observed in patients with the more advanced stage of chronic lower-extremity ischemia."

Lower-limb ischemia due to blockage of peripheral arteries is common in patients with end-stage renal disease, Dr. Bonomini of Ospedale Clinicizzato SS Annunziata, Chieta and his colleagues note in the American Journal of Kidney Diseases. Some patients, they add, are not candidates for surgery or angioplasty to improve blood flow and may have to undergo amputation.

To determine if spinal cord stimulation might help avoid amputation in these circumstances, the researchers implanted the devices in eight hemodialysis patients with renal failure and lower-limb ischemia.

Follow-up for as long as a year showed that there were no complications from the implantation and the patients' intensity of pain and quality of life improved considerably. The amount of pain medication was also reduced.

While skin lesion present before implantation did not improve, no new lesions developed during the study period.

The researchers conclude that spinal cord stimulation "dramatically improves quality of life and pain relief " and may help certain patients delay or avoid amputation.

SOURCE: American Journal of Kidney Diseases, May 2006.