Disclosures: Stephen K. Anderson, MD: Nothing to disclose

Case Description: Spinal cord stimulator (SCS) for radiation fibrosis associated rectal pain.

Setting: Outpatient pain management center.

Patient: A 37-year-old male with history of Lynch syndrome, rectal cancer status-post chemotherapy and radiation with low anterior resection and revision to loop colostomy with delayed-onset severe rectal pain.

Assessment/Results: A 37-year-old male was diagnosed with rectal cancer and underwent chemotherapy, radiation and ostomy takedown in 2016. He later developed delayed onset severe rectal pain and was subsequently hospitalized multiple times for uncontrolled rectal pain. He was referred to pain clinic for further evaluation of severe rectal pain, and at that time rectal pain was reported to be 7/10 in severity. He subsequently underwent ganglion impar block and was noted to have significant scar tissue and radiation fibrosis in the rectal area which was determined to be a significant contributor to his pain complaints. The patient reported to have only several hours of relief from the ganglion impar block, and the placement of a SCS was discussed. He was cleared by rehabilitation psychology and subsequently underwent successful placement of SCS with tip placement around the conus medullaris. In follow-up after SCS placement, he noted significant relief in his rectal pain, reporting improvement in severity to 1/10. The patient later developed an infection at the battery site of his SCS and this was removed. Patient then elected to have SCS replaced and continued with ongoing relief of rectal pain.

Discussion: Radiation fibrosis is an uncommon finding in the rectal area after radiation therapy for rectal cancer and can cause significant pain and impairment. Our patient gained significant rectal pain relief after placement of SCS.

Conclusion: Spinal cord stimulator may provide significant relief of rectal pain in patients with radiation fibrosis associated rectal pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-stimulator-scs-for-radiation-fibrosis-associated-rectal-pain/