Neuromodulation : journal of the International Neuromodulation Society
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Postherpetic neuralgia (PHN) is the most common complication following an acute varicella zoster virus infection. PHN often results in a chronic severe pain condition refractory to conservative pain management treatments. Peripheral nerve stimulation over the affected spinal nerve root may be an effective treatment option for patients with intractable PHN. ⋯ We describe a case of successful electrode placement at the C2 spinal level for the treatment of refractory PHN.
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The use of cervical spinal cord stimulators for the treatment of refractory neck and upper extremity pain is widely accepted and growing in use as a treatment modality. This case highlights a previously unreported potential complication of spinal cord stimulators. ⋯ As more patients are undergoing implantation of spinal cord stimulators we must be aware of the long-term risks that can be encountered.
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Patients suffering from severe chronic angina pectoris (AP) that has become therapeutically refractory to medication and revascularization can be adequately treated with spinal cord stimulation (SCS). However, following SCS implantation for angina, not all patients show a consistent improvement in quality of life (QoL). Therefore, we sought to study the association of baseline characteristics and chronic multimorbidities on QoL following SCS implantation. ⋯ Men showed a larger improvement in QoL following SCS implantation, compared with women. As SCS improves rAP, other chronic morbidities such as COPD, DM, and BMI may become the limiting factors for exercise and subsequently adversely affect QoL following implantation of an SCS system. As a consequence of the present relatively small single-center study, we recommend studies regarding rAP and SCS to also address the effect of comorbidities on outcomes.
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Case Reports
Ultrasound-guided caudad epidural access for the lumbosacral neurostimulation: case report and technical note.
This is a case report and description of a new ultrasound-guided caudad epidural needle placement for percutaneous stimulation of the lumbosacral roots. ⋯ Spinal sonography is a promising imaging method to facilitate percutaneous caudad epidural access.
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Neurostimulation is widely accepted for the treatment of refractory Parkinson's disease, essential tremor, and chronic pain. The presence of a cardiovascular implantable electronic device (CIED) might be considered a contraindication for neurostimulators due to the possible interaction between the two devices. The purpose of this study is to report the feasibility and safety of concomitant use of neurostimulators and CIED, and to review surgical and clinical precautions needed to avoid possible interference between the two systems. ⋯ The concomitant use of neurostimulator(s) and permanent pacemaker(s) can be safely performed. Permanent pacemaker should not be considered a general contraindication for neurostimulation therapy. Current literature lacks evidence to determine the safety of concomitant use of neurostimulator(s) and implantable cardioverter defibrillator(s).