Neuromodulation : journal of the International Neuromodulation Society
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Observational Study
Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up.
Spinal cord stimulation (SCS) remains poorly efficient at reducing back pain in failed back surgery syndrome (FBSS) patients. We aimed at determining whether a new multicolumn lead SCS technique was efficient at durably reducing their leg (LP) and back (BP) pain. ⋯ Multicolumn lead SCS in FBSS patients significantly improve BP, LP, quality of life, and medication consumption for at least 36 months. A classical placebo effect cannot account for long-term improvements of such magnitude.
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To illustrate the obstacles and problems with electrical fields (EFs) in treatment and management of skin wounds. Unlike the literature that gives evidence for EF promoting wound healing, there is relatively little research to illustrate the interference of wound healing with EFs. ⋯ It is possible that EF can also negatively impact healing of a wound, and thus should be a consideration to clinicians when a delay in proper wound healing is encountered postoperatively. Therefore, in the postoperative period, when the wound healing is most active, we recommend avoiding programs that require frequent pulse generator recharges.
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Conventional dorsal column spinal cord stimulation (SCS) provides less than optimal pain relief for certain pain syndromes and anatomic pain distributions. Practitioners have sought to treat these challenging therapeutic areas with stimulation of alternate intraspinal targets. ⋯ Clinical use of intraspinal neurostimulation is expanding at a very fast pace. Intraspinal stimulation of non-dorsal column targets may well be the future of neurostimulation as it provides new clinically significant neuromodulation of specific therapeutic targets that are not well or not easily addressed with conventional dorsal column SCS. In addition, they may avoid undesired stimulation induced paraesthesia, particularly in non-painful areas of the body.
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Comparative Study Observational Study
Burst or High-Frequency (10 kHz) Spinal Cord Stimulation in Failed Back Surgery Syndrome Patients With Predominant Back Pain: One Year Comparative Data.
Burst and 10 kHz spinal cord stimulation (SCS) demonstrated improvement for failed back surgery syndrome (FBSS) with predominant, refractory back pain. Here, we report the long-term follow-up of a previously published study comparing the safety and efficacy of burst vs. 10 kHz SCS for predominant back pain (70% of global pain) of FBSS patients. ⋯ Long-term data of this comparative study suggests that burst responsiveness was superior to 10 kHz in our small-scale cohort, thus a larger, randomized-controlled comparative study design is highly recommended.
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One complication associated with the refill procedure of intrathecal drug delivery systems (IDDSs) include a "pocket fill," which is the inadvertent injection of the drug into the subcutaneous space surrounding the pump. The purpose of our study was to assess the mean volume discrepancy between the injected and the effective drug volume inside the IDDS reservoir after refills that did not lead to signs of overdose and to record at which volume discrepancy symptoms of overdose were noticed. ⋯ A volume discrepancy of >1 mL in 20 mL IDDSs and of >2 mL in 40 mL IDDSs after refill should be regarded as potentially consequential with regard to risk of overdose possibly caused by a pocket fill. In case of potentially consequential volume discrepancies, hospitalization and monitoring is recommended to preclude late overdose symptoms outside the hospital.