Immediate pain relief with burst spinal cord stimulation in Parkinson’s disease: A two-case report

• Burst SCS provided immediate pain relief upon activation in PD patients. • Postural abnormalities improved simultaneously with pain reduction. • Effects reversed rapidly when stimulation was discontinued. • SCS remained effective even after previous DBS therapy. • First documentation of immediate-onset effects in PD treatment. Parkinson’s disease (PD) is characterized by high rates of refractory pain, with >60 % of the patients experiencing lower back and lower limb pain. Although spinal cord stimulation (SCS) has emerged as a promising treatment for PD-related symptoms, previous studies have not specifically documented the onset time of therapeutic effects. However, the temporal dynamics of its effects, particularly with burst stimulation, remain poorly understood. We report two cases of burst stimulation SCS applied at the lower thoracic spine level for the treatment of PD-related lower back pain, lower limb pain, and postural abnormalities. Conventional treatments, including medication and nerve blocks, failed in both patients. The first patient showed significant improvement, with numerical rating scale (NRS) pain scores decreasing from 5 to 1 at rest and 8 to 3 during activity, along with improved sagittal vertical axis measurements (118 mm to 67 mm). The second patient, who had previously undergone deep brain stimulation, demonstrated NRS improvement from 7 to 3 and a marked improvement in cervical anteflexion. Both patients experienced immediate pain relief upon stimulation and rapid symptom recurrence upon deactivation. These improvements were maintained over a two-year follow-up period without requiring increased medication. These cases demonstrate that burst stimulation SCS can provide immediate, reversible pain relief and postural improvement in patients with PD, even after deep brain stimulation. The rapid onset and offset of these effects suggest direct modulation of neural circuits rather than gradual neuroplastic changes, presenting a novel therapeutic mechanism worthy of further investigation.