Neuromodulation : journal of the International Neuromodulation Society
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Review
Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation.
The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS. ⋯ Our study demonstrates that there is a significant increase in cost and healthcare resource utilization one-year prior to and around the time of CRPS diagnosis. Furthermore, there is an increased annual cost post-diagnosis compared to baseline costs prior to CRPS diagnosis.
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Review
Burst Spinal Cord Stimulation: Review of Preclinical Studies and Comments on Clinical Outcomes.
Burst spinal cord stimulation (SCS) technology uses a novel waveform that consists of closely packed high-frequency electrical impulses followed by a quiescent period. Within the growing field of neuromodulation, burst stimulation is unique in that it mimics the natural burst firing of the nervous system, in particular the thalamo-cingulate rhythmicity, resulting in modulation of the affective and attentional components of pain processing (e.g., medial thalamic pathways). ⋯ Burst stimulation offers a novel pain reduction tool with the absence of uncomfortable paresthesia for failed back surgery syndrome, diabetic neuropathic pain, and anesthesia dolorosa. Preclinical models have emphasized that the potential mechanisms for burst therapy could be related to neural coding algorithms that mimic the natural nervous system firing patterns, resulting in effects on both the medial and lateral pain pathways. Other mechanisms include frequency dependent opioid release, modulation of the pain gate, and activation of electrical and chemical synapses.
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Delayed paraplegia due to spinal cord ischemia/reperfusion injury (IRI) remains one of the most severe complications of thoracoabdominal aneurysm surgery, for which effective prevention and treatment is still lacking. ⋯ SCS postconditioning at 2 Hz protected the spinal cord from IRI.
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The extent to which short interval intracortical inhibition (SICI) responds to low-frequency repetitive transcranial magnetic stimulation (rTMS) remains inconclusive with reports of increased, decreased and unchanged response following modulation. The aim of this study was to systematically investigate if the variability of SICI following rTMS is explained by the interstimulus interval (ISI) and/or the conditioning stimulus intensity (CSI). ⋯ The optimal ISI or CSI did not shift or reveal SICI changes after inhibitory rTMS. However, when the whole curve of SICI responses were evaluated from a wide range of ISIs, a decrease in inhibition was found. The contrast between the results of individual ISI tests and the wide range of ISI assessment may be due to higher intersubject variability of SICI and/or sample size, rendering traditional SICI testing methods ineffective for measuring changes in inhibition. Further, it is possible that rTMS modulates GABAA and GABAB mediated inhibitory processes differently, which would explain the conflicting results for SICI and cSP.