Neuromodulation : journal of the International Neuromodulation Society
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Currently accepted chronic pain treatment algorithms have positioned therapies according to levels of invasiveness and up-front costs. After reviewing updated literature on efficacy and cost outcomes of care for patients with chronic pain that include interventional implantable technologies, we offer a new model of thinking when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles. These SAFE principles include "safety,"appropriateness,"fiscal neutrality," and "efficacy."
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Objectives. The increased rigidity and spasms implicit to patients being treated with baclofen provide a potential source of drug delivery system-related complications. Placement of the intrathecal catheter from the far-lateral paraspinal approach has been advocated to avoid catheter fracture as previously reported with a midline approach. A thin fascial layer and increased muscle bulk laterally could increase motion of catheters placed in this position. ⋯ Mean time to catheter revision following implantation was 7 ± 2 months. Conclusions. Spinal catheter migration from the subarachnoid space can occur with intrathecal baclofen infusion systems. Alternative methods for spinal catheter placement warrant further study.
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Objectives. This study attempts to confirm the hypothesis that transcutaneous electrical stimulation (TENS) of peripheral Aβ fibers inhibits nociceptive processing, by quantifying the change of laser-evoked potential (LEP) components, using a 980-nm diode laser. Materials and Methods. Cutaneous heat stimuli were delivered to the dorsum of the right hand in 13 volunteers. LEPs and pain intensity ratings were recorded before, during, and after the use of TENS (110 Hz) at the dorsolateral forearm. ⋯ After 10 min of TENS this was associated with a clinically relevant decrease of pain intensity. Conclusions. Our data suggest that TENS inhibits nociceptive processing. Ten minutes of TENS exerts a clinically relevant pain reduction.