Neuromodulation : journal of the International Neuromodulation Society
-
Objectives Intraspinal drug delivery via indwelling pump is an effective means of treating refractory pain. Before a patient is selected for pump implantation, an intraspinal drug delivery trial must be performed to establish side-effects and efficacy profiles. No consensus protocol currently exists for such trials. ⋯ Nearly half (45%) of the respondents use the continuous intrathecal infusion technique to select patients for permanent implants. Conclusions Trial practices vary widely in terms of patient selection, medication choice, technique, and efficacy evaluation. We hope that our findings will encourage a concerted effort to evaluate existing trial protocols in order to establish a reliable standard of care.
-
Objectives The objective of this paper is to report the clinical protocols that we have developed and used for titrating constant flow implantable pumps to an effective dose in de novo pain and spasticity pump patients and, thereby, highlight the similarities and differences in our techniques. As a group, we have implanted over 1600 pumps and currently manage over 800 pump patients. ⋯ This compares favorably to reports of programmable pumps requiring 5.3 ± 3.5 adjustments over a period of 3-6 months to reach an effective dose. Conclusions A comparison of our protocols shows that after an initial stabilization period, dose adjustments can be made at subsequent refill, that it is not necessary to adjust the dose by prematurely emptying and filling constant flow pumps, and that it is not necessary to adjust the dose as often as has been done with programmable pumps.
-
Sjögren syndrome is a chronic autoimmune disease. This disease mainly involves salivary and lacrimal glands, although it may also involve the musculoskeletal, respiratory, gastrointestinal, renal, hepato-biliary, hematological, neurological, vascular, or both systems. Small vessel disease may appear in up to 30% of the cases. ⋯ In our pain unit, a percutaneous posterior spinal cord stimulator (SCS) was placed. SCS clinically reduced her pain by 90% and helped to improve her quality of life and significantly reduced her intake of analgesics. We conclude spinal cord stimulation may be a good alternative to conservative therapies in patients with vasculitis of Sjögren syndrome.
-
Objective To compare the technical performance of different percutaneous lead types for spinal cord stimulation. Methods Using the ut-scs software (University of Twente's spinal cord stimulation), lead models having similar characteristics such as the 3487A PISCES-Quad (PQ), 3887 PISCES-Quad Compact (PC), 3888 PISCES-Quad Plus (PP) (Medtronic Inc., Minneapolis, MN), and the AB SC2108 (AB) (Advanced Bionics Corp., Valencia, CA) were simulated in monopolar and tripolar (guarded cathode) combinations on a single lead, placed just outside the dorsal dura mater and both centered on the spinal cord midline, and at 1 mm lateral. The influence of displacing a lead dorsally in the epidural fat was examined as well. ⋯ Conclusions Complex pain syndromes are treated best with lead having a small contact spacing, being programmed as a tripole (guarded cathode) and centered on the spinal cord midline just outside the dura mater. This is because dorsal column fiber recruitment is more extensive than with any other combinations, including dual leads. Improved recruitment of dorsal column fibers is accompanied by increased energy consumption.