Neuromodulation : journal of the International Neuromodulation Society
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Sacral neuromodulation (SNM) is an approved method for second-line treatment of different therapy refractory disorders of the urinary bladder. Alongside success in overactive bladder symptoms for detrusor overactivity, SNM also was shown to succeed in chronic urinary retention (UR) of various etiology. ⋯ SNM can be a successful and secure second-line therapy option for patients with chronic UR. Data suggest a more success-promising situation for idiopathic cause of disease, but the number of patients was too small to reach statistical significance. Further prospective, randomized multicenter data concerning indications and number of electrodes are necessary and highly appreciated.
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Editorial Review Historical Article
Evidence-based review of neuromodulation for complex regional pain syndrome: a conflict between faith and science?
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Spinal cord stimulation (SCS) is a valid option for intractable neuropathic pain syndromes, yet some patients cannot undergo the standard awake procedure. Our retrospective study chronicles laminectomy-electrode placement for SCS under general anesthesia and use of compound muscle action potentials (CMAPs) to guide placement in the absence of patient verbal feedback. ⋯ With electrophysiologic monitoring and fluoroscopy guidance, placement of SCS laminectomy leads in select patients under general anesthesia may result in appropriate stimulation coverage and pain relief in most.
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Trialing for intrathecal pump placement is an essential part of the decision-making process in placing a permanent device. In both the United States and the international community, the proper method for trialing is ill defined. ⋯ The use of intrathecal drug delivery is an important part of the treatment algorithm for moderate to severe chronic pain. It has become common practice to perform a temporary neuroaxial infusion before permanent device implantation. On the basis of current knowledge, the PACC has developed recommendations to improve care. The need to update these recommendations will be very important as new literature is published.
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Targeted intrathecal drug infusion to treat moderate to severe chronic pain has become a standard part of treatment algorithms when more conservative options fail. This therapy is well established in the literature, has shown efficacy, and is an important tool for the treatment of both cancer and noncancer pain; however, it has become clear in recent years that intrathecal drug delivery is associated with risks for serious morbidity and mortality. ⋯ Targeted intrathecal drug delivery systems are associated with risks for morbidity and mortality that can be devastating. The panel has given guidance to treating physicians and healthcare providers to reduce the incidence of these problems and to improve outcomes when problems occur.