Pain-induced autonomic dysreflexia secondary to spinal cord injury with significant improvement after spinal cord stimulator implantation.

Introduction: Spinal cord stimulation (SCS) has been established as a safe and effective alternative treatment for many conditions. This is a unique case involving SCS in spinal cord injury (SCI) patients with recurrent episodes of autonomic dysreflexia (AD). AD is a sympathetically driven reflexive hypertension in response to a noxious stimuli below the neurological level of spinal cord injury. There is currently limited research and literature regarding SCS application for AD. We present a unique case where pain-induced AD was successfully treated with implantation of SCS, in order to avoid long term opioid use and improve quality of life. Case presentation: We present a 46-year-old female, with history of chronic incomplete traumatic quadriplegia, with increased frequency of symptomatic AD. After an extensive work-up, it was determined that the likely trigger for the AD episodes was neuropathic and nociceptive pain below the level of the spinal cord injury. Due to the frequency of AD episodes, uncontrolled pain, and concerns of long term opioid usage, she was referred for an evaluation for possible SCS placement. The patient ultimately underwent SCS implantation and battery revision. She had significant improvement of AD episodes after SCS implantation. Conclusion: This case identifies a unique approach to preventing AD episodes by addressing intractable neuropathic pain with SCS.