Neuromodulation : journal of the International Neuromodulation Society
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Currently little objective evidence exists regarding the phenotype or somato-sensory profile of patients with Failed Back Surgery Syndrome (FBSS). The aim of this study is to characterize the somato-sensory profile of the patients with FBSS undergoing spinal cord stimulation (SCS). ⋯ Although very low numbers, we could demonstrate the somatosensory profiles of patients with FBSS undergoing SCS. Early indication may associate an efficient CPM profile having a higher chance of an unsuccessful implant at three months.
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There is increasing literature evidence both clinically and experimentally on the existence of potent, adaptive interactions between the central and peripheral aspects of the neuroimmune system in the genesis and maintenance of chronic neuropathic extremity pain and nociceptive back pain. The neuroinflammatory pathways are modulated by the interaction of pro- and anti-inflammatory cytokines and chemokines, which are released by peripheral immune system-derived cell species (macrophages and leukocytes). This review examines the possible impact of spinal and peripheral neurostimulation on the inflammatory response in the context of acute and chronic pain pathologies of different origin. ⋯ These preliminary findings may have important implications on the potential applications of neurostimulation as an anti-inflammatory therapy and the role of molecular profiling as a preimplant screening modality and post-implant outcome validation. Thus, future targeted clinical and experimental research is highly warranted in this particular novel field of neuromodulation.
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In spinal cord stimulation (SCS), the electrical stimulation of the spinal cord with an implanted lead evokes a tingling peripheral sensation known as paresthesias. Newer stimulation paradigms allow paresthesia-free treatment, but during the implantation of the lead, paresthesias must cover the painful area to achieve optimal treatment effect. The localization of the evoked paresthesias can be difficult to accurately describe for the patient, and furthermore depends on a complex and only partially predictable set of parameters that includes the anatomical localization and the programming of the electrical field. We aimed to optimize SCS implantation procedures by devising a way to aid the patient in making useful descriptions of the evoked paresthesias, then to visually convey the full set of information-anatomical position of the lead, programming parameters, and evoked paresthesias-directly to the implanting physician. ⋯ We present an Implanter's Integrated Information (I3) system; a simple, inexpensive solution for gathering, integrating, and conveying the complex set of information necessary for a successful SCS procedure.