Neuromodulation : journal of the International Neuromodulation Society
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Introduction. Spinal cord stimulation (SCS) is used clinically by many pain physicians and neurosurgeons alike without regard to their own outcome data. Methods. We reviewed our 20-year experience retrospectively of patients receiving SCS implants and analyzed our data by pain type and group. Results. We present 260 patients, 140 men and 120 women. ⋯ The therapy was not free of complications. The preponderance of our patients was patients with the diagnosis of PVD and our results in this group of patients were excellent. These excellent results of more than 90% improvement suggest to us that SCS be considered as a first-line approach to the clinical management of patients with pain and ulcer of PVD.
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Objectives. Post-herpetic neuralgia (PHN) is a painful complication of herpes zoster infection and a common cause of chronic severe pain in elderly and/or debilitated patients. Although a wide range of treatments have been tried, a substantial number of patients continue to experience pain which remains refractory to all therapies. Increasingly, studies have demonstrated that oral opioids can have a beneficial effect on neuropathic pain. ⋯ Patients most commonly reported improvement in the deep component of their pain, next allodynia, and less so superficial lancinating pain. Conclusions. In conclusion, while a complex therapy, long-term use of intrathecal opioids is well tolerated, doses are titratable, administration is safe, and may help relieve severe short- and long-term neuropathic pain in selected PHN patients. Whether the addition of newer investigational intrathecal agents could improve these results is yet to be determined.
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Objectives. This study aims to assess the efficacy of intrathecal infusion in different types of pain. A number of different variables were assessed to analyze their effect on therapy and to determine in which patients intrathecal infusion is more effective. Materials and Methods. A retrospective study was conducted with data obtained from 1983 to 2002. ⋯ The multivariate analysis (logistic regression analysis) revealed a significant difference with regard to gender, with an odds ratio of 2.78 in favor of male gender. When the efficacy and safety of the infusion was compared to the dose of morphine used, no significant differences were observed, with p = 0.65 for efficacy and p = 0.69 for safety. Conclusions. Pain relief was obtained with this technique in approximately 70% of patients, with no differences between pain types, but with a significant difference in favor of male gender.
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In current medical literature, most reported complications during spinal cord stimulation (SCS) concern technical problems, such as malfunction, migration or breakage of the lead, or internal pulse generator dysfunction, while reports about side-effects caused by SCS are rare. In this clinical report, we describe uncommon and unexplained gastrointestinal (GI) side-effects of constipation, abdominal pain, and distension during SCS in a patient suffering for chronic neuropathic pain caused by failed back surgery syndrome. These GI symptoms disappeared after suspension of SCS and were reduced if the stimulation settings were reduced below paresthesia threshold. The symptoms experienced by our patient could be related to a functional and reversible block of parasympathetic outflow in the GI system since SCS may involve not only dorsal horn structures but also somatic and visceral sensory afferents to these structures in an unpredictable way.
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Background. Buerger disease is a nonatherosclerotic, segmental, occlusive and recurrent inflammatory vascular disorder that affects small and medium-sized arteries and veins of the upper and lower extremities. Case reports. We report two cases of Buerger disease. Medical History. Smoking habit. ⋯ Following all of the above treatments, Synergy(®) spinal cord (ECP) stimulator with two electrodes (Quad PISCES(©) ) placed at the level of T9-T10. Results. There has been a reduction in pain of about 80% and an improvement of intermittent claudication (one of the patients no longer claudicates, whereas the other patient claudicates at 400 m). Conclusion. Neurostimulation of the posterior funiculi could be considered not only as palliative care but also as a therapeutic option.