1. 2015;18;E643-E650The Use of Spinal Cord Neuromodulation in the Management of HIV-Related Polyneuropathy
   Case Report
   Nebojsa Nick Knezevic, MD, PhD, Kenneth D. Candido, MD, Shalini Rana, MD, and Ivana Knezevic, MD.

BACKGROUND: The prevalence of HIV-related neuropathy may rise nationwide as Highly Active Antiretroviral Therapy (HAART) usage and HIV-survival rates increase, resulting in higher referral rates to pain practitioners for analgesic strategies. However, if patients’ symptoms are refractory to conservative measures, an advanced interventional approach may be indicated.
OBJECTIVE: We present 2 cases of successful use of spinal cord neuromodulation in the treatment of HIV-related neuropathy.
STUDY DESIGN: Case Report
METHODS: One patient experienced severe lower extremity burning pain, progressively worsening over the past 6 years. He had trouble ambulating, and pain was refractory to conservative treatments. The other patient suffered from low back pain and distal symmetrical polyneuropathy. A remote lumbar discectomy prior to his development of HIV disease resulted in marked improvement in lumbar spinal pain, but subsequent later development of neuropathic pain remained refractory to different treatment modalities.
RESULTS: Both patients reported more than 90% improvement in pain during the spinal cord stimulator (SCS) trial, which led to permanent SCS implantation with equivalent success rates. One of them was followed up for 3 years, and another one for 14 months before he moved overseas. Both of them reported an improved quality of life, reductions in the use of oral opioid analgesics, and increased ability to participate in daily activities without limitations. Neither patient sustained any infectious complications, lead migration, or required battery changes.
LIMITATIONS: Controlled double blinded studies with a higher number of patients are needed to prove efficacy in these patients.
CONCLUSION: These 2 cases demonstrate that SCS neuromodulation is a safe, viable, and efficacious option for patients whose HIV-related neuropathic type pain is refractory to conventional treatment modalities. Our patients appear to be the first case reports that show a remarkable efficacy of SCS in the management of HIV-related polyneuropathy.