Neuromodulation : journal of the International Neuromodulation Society
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Review
Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders.
The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms. ⋯ A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
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Low back pain (LBP) is a highly prevalent condition and one of the leading causes of lost productivity and health-care costs. The objective of this review is to discuss the role of interventional pain procedures and evidence of their effectiveness in treatment of chronic LBP. ⋯ Implementation of interventional pain procedures in the treatment framework of LBP has resulted in improvement of pain intensity in at least the short and medium terms, but equivocal results have been observed in functional improvement.
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Review
A review of economic factors related to the delivery of health care for chronic low back pain.
We describe tools used to evaluate the economic impact of health care interventions, discuss the economic burden of chronic low back pain, and review evidence on the cost-effectiveness of treating failed back surgery syndrome with spinal cord stimulation, intrathecal drug delivery, acupuncture, epidural injections, disc prosthesis, lumbar fusion, and noninvasive therapies. We also mention the lack of cost studies for emerging therapies, such as vibrotherapy and peripheral nerve field stimulation. Topics include types of cost studies; the economic perspectives taken by such studies; direct and indirect costs; measures of success; definitions of cost-effectiveness, incremental cost-effectiveness, incremental cost-utility ratios, and quality-adjusted life years; the concept of maximum willingness to pay; and the use of cost-effectiveness models. ⋯ The fact that chronic low back pain arises from a variety of causes makes choosing appropriate treatment difficult. Determining the cost-effectiveness of various treatments for chronic low back pain depends on well-designed and well-executed randomized controlled trials with parallel economic evaluations. Researchers can use economic models to extrapolate costs and outcomes over the long term.
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To review spine surgery management strategies for patients with chronic low back pain (CLBP) that has failed to respond to all nonsurgical treatment options. ⋯ Despite the number of spine surgeries that have been performed for CLBP, the surgical outcome still remains questionable. Until a precise identification of the cause of CLBP in any given patient can be precisely determined, surgical solutions will continue to be less than optimal.
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Chronic low back pain (CLBP) is common and contributes to significant disability and healthcare costs. The mechanism and etiology of CLBP are frequently unclear, and treatment choices vary. ⋯ Personalized treatment plans should be informed by response to therapies previously tried, the severity and persistence of symptoms, and the availability of specialist expertise.