Neuromodulation : journal of the International Neuromodulation Society
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Objective. This study examines, in a retrospective fashion, the effects of intraspinal infusion therapy in 36 patients with pain of non-cancer origin. In those cases where pain was recalcitrant to the infused opiate and/or had a neuropathic component, a local anesthetic, tetracaine, was added. ⋯ Conclusion. The results support the potential utility of infusion therapy in the treatment of non-cancer pain. This treatment, however, is not without problems and should be applied judiciously and in the context of evolving guidelines.
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Introduction and Methods. A prospective, open case study was performed on 37 patients, given intrathecal (IT) bupivacaine alone or bupivacaine/opioid combinations for refractory pain located in the extremities to explore the potential of this therapy for prophylaxis against post-amputation pain (PLP) and/or the treatment of severe, established PLP. Intrathecal infusions were administered before, during, and after amputation, as an attempt to prevent PLP ("prophylaxis group"; n = 21), or to relieve existing severe PLP after previous amputations ("treatment group"; n = 16). ⋯ Conclusions. Continuous IT infusion of bupivacaine with or without opioid gave satisfactory pain relief during the treatment in 95% of the patients. Continuous IT infusion of bupivacaine, alone or in combination with opioid, relieved severe preexisting PLP during the treatment in 100% of the treated patients, but did not prevent its recurrence after the end of the intrathecal treatment.
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Objective. To test the following hypotheses, based on computer modeling studies of spinal cord stimulation, by the analysis of data from chronic pain patients: I. the probability-of-paresthesia in a dermatome is highest when the cathode is placed at the corresponding segmental level; II. variation of the rostrocaudal position of the cathode in the lower cervical/high thoracic region results in less variation of the probability-of-paresthesia in a dermatome than stimulation in more caudal regions; III. when stimulating in the midthoracic region, the probability-of-paresthesia in a dermatome is low in comparison to other regions when the cathode is not at the corresponding segmental level. Method. ⋯ Conclusion. The success to be expected from spinal cord stimulation in chronic pain management is inversely related to the thickness of the dorsal cerebrospinal fluid layer at the cathode level. Therefore, preoperative measurement from transverse images can be helpful as a predictor for success.