Neuromodulation : journal of the International Neuromodulation Society
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Ziconotide is a non-opioid analgesic for intrathecal (IT) administration. The aim of this review is to provide a comprehensive and clinically relevant summary of the literature on dosing and administration with IT ziconotide in the management of refractory chronic pain, and to describe novel dosing strategies intended to improve clinical outcomes. ⋯ Clinical trials and experience confirm the feasibility and usefulness of IT ziconotide in the management of refractory chronic pain. Emerging evidence suggests that additional IT delivery options may further expand the usefulness and benefits of ziconotide.
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Observational Study
Longer Delay From Chronic Pain to Spinal Cord Stimulation Results in Higher Healthcare Resource Utilization.
A shorter delay time from chronic pain diagnosis to spinal cord stimulation (SCS) implantation may make it more likely to achieve lasting therapeutic efficacy with SCS. The objective of this analysis was to determine the impact of pain-to-SCS time on patients' post-implant healthcare resource utilization (HCRU). ⋯ HCRU increased in the year following SCS implantation with longer pain-to-SCS time. These results suggest that considering SCS earlier in the care continuum for chronic pain may improve patient outcomes, with reductions in hospitalizations, clinic visits, and opioid usage.
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Spinal cord stimulation (SCS) is used for treating intractable neuropathic pain. It has been suggested that burst SCS (five pulses at 500 Hz, delivered 40 times per second) suppresses neuropathic pain at least as well as conventional tonic SCS, but without evoking paraesthesia. The efficacy of paraesthesia-free high and low amplitude burst SCS for the treatment of neuropathic pain in patients who are already familiar with tonic SCS was evaluated. ⋯ Burst stimulation is in general more effective than tonic stimulation. Individual patients can highly benefit from burst stimulation; however, the therapeutic range of burst stimulation amplitudes requires individual assessment.
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Chronic pain is a debilitating biologic and psychologic condition which affects nearly one third of the American population with an annual cost of $560 to $635 billion from associated health care costs and lost productivity. Treatment of chronic pain is difficult to objectively evaluate as it relies on subjective measure. An objective measure would be beneficial in assessing treatment efficacy and towards developing a closed loop system. We assess the efficacy of pedometry as an objective measure of treatment efficacy in spinal cord stimulation (SCS). ⋯ We demonstrate a mean improvement of more than 50% in distance walked, steps per hour, and total steps. Interestingly, total activity (number of hours spent active per day) was not dramatically improved. Our data suggests that as a group our patients' ambulation increased dramatically after successful SCS. The use of pedometry in conjunction with self-reporting can lend both quantitative and qualitative validity to pain, as well as allow objective assessment of efficacy of SCS in patients suffering from chronic low back and/or leg pain. Further, external sensors tracking these data may be a means of creating a closed loop system with SCS.