Neuromodulation : journal of the International Neuromodulation Society
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Randomized Controlled Trial Comparative Study
Comparison of Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, and Association of Both in Patients With Refractory Chronic Back and/or Lower Limb Neuropathic Pain: A Prospective, Randomized, Double-Blind, Cross-Over Trial (BOOST-DRG Study).
Spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRGS) have individually shown efficacy in relieving pain in patients with persistent spinal pain syndrome after spinal surgery (PSPS-T2). Combining SCS and DRGS simultaneously, along with Burst stimulation programming, may enhance the responder rate of patients with PSPS-T2. ⋯ The full option to stimulate different neural structures, separately or simultaneously, led to improved responder rates, allowing patients to personalize treatment. A multidimensional assessment is essential to reveal the full potential benefits of neuromodulation in patients with chronic pain.
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Cancer pain is among the most prevalent and challenging symptoms in cancer care, with up to 95% of patients with late-stage cancer experiencing moderate-to-severe pain. Conventional pharmacologic treatments, including opioids, carry risks, and patients' conditions may be refractory to medical management or have contraindications. Neurostimulation techniques, such as spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRGS), and peripheral nerve stimulation (PNS), have shown promise in treating treatment-induced cancer pain. However, a comprehensive review focusing on these techniques for cancer-induced pain alone is necessary. ⋯ Our scoping review synthesizes evidence on neurostimulation interventions for treating cancer-induced pain. Current evidence suggests that interventions such as SCS, DRGS, and PNS may provide clinically meaningful pain relief in patients with cancer-induced pain. Several studies also reported improvements in functionality and quality of life. However, the level of evidence is limited owing to the lack of prospective comparative studies, clinical and methodologic heterogeneity, and small sample sizes.
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During the last decade, the complementary value of real-world data (through registries or medical records) and data from randomized clinical trials has been recognized as increasingly important. In the field of neuromodulation, only a few industry-independent nationwide neuromodulation registries are available. The interest in creating a European registry has increased but without a successful result. The goal of this online survey is to gain further insights into the need for and burden of a European registry for neuromodulation. ⋯ More than 90% of the respondents believed that a European registry for neuromodulation is needed, mainly to obtain real-world (big) data about the effectiveness and safety of this therapy. This survey clearly pointed to the need for a European registry for which it seems key to ensure financial and logistical support, in addition to in-depth legal guidance in developing this registry.
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Review Meta Analysis
Noninfectious Complications of Dorsal Root Ganglion Stimulation: A Systematic Review and Meta-Analysis.
Dorsal root ganglion stimulation (DRGS) has emerged as a promising treatment for chronic neuropathic pain. However, its safety and complications are not fully understood, with existing literature primarily based on case reports, observational studies, and data base analyses. This systematic review and meta-analysis aims to assess the prevalence of noninfectious complications associated with DRGS, focusing on the trial phase, postimplantation period, and revisions, while identifying risk factors for these outcomes. ⋯ DRGS shows a safety profile comparable to that of spinal cord stimulation, with similar rates of lead migrations and fractures. Improvements in surgical techniques, technology, and clinician expertise are expected to reduce complications. Future research should standardize reporting practices and detail implantation techniques to better understand and refine best practices in DRGS implantation.
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Randomized Controlled Trial
Effects of Pulsed Radiofrequency Duration in Patients With Chronic Lumbosacral Radicular Pain: A Randomized Double-Blind Study.
We hypothesized that the duration of pulsed radiofrequency (PRF) application may affect the effectiveness of PRF in patients with chronic lumbosacral radicular pain (LRP). ⋯ The Clinicaltrials.gov registration number under the Clinical Trial Registry of Korea for the study is KCT0003850; https://cris.nih.go.kr.