Neuromodulation : journal of the International Neuromodulation Society
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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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Objectives. This study attempts to confirm the hypothesis that transcutaneous electrical stimulation (TENS) of peripheral Aβ fibers inhibits nociceptive processing, by quantifying the change of laser-evoked potential (LEP) components, using a 980-nm diode laser. Materials and Methods. Cutaneous heat stimuli were delivered to the dorsum of the right hand in 13 volunteers. LEPs and pain intensity ratings were recorded before, during, and after the use of TENS (110 Hz) at the dorsolateral forearm. ⋯ After 10 min of TENS this was associated with a clinically relevant decrease of pain intensity. Conclusions. Our data suggest that TENS inhibits nociceptive processing. Ten minutes of TENS exerts a clinically relevant pain reduction.
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Introduction. Spinal cord stimulation (SCS) is an effective treatment option for neuropathic pain. However, because of the obvious procedural issues, SCS is unable to reach certain areas, such as the face, thorax, coccyx, the cervico-dorsal and lumbar areas, and the sacral, abdominal, and inguinal regions. On the other hand, these areas are easily reached by subcutaneous field stimulation. ⋯ As a result of pain reduction, the patients' quality of life improved. There were no adverse events reported except for early electrode array displacement in two of our patients. Conclusion. When SCS is not appropriate for certain neuropathic pain syndromes, subcutaneous field stimulation may be used with some degree of efficacy.
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The history of the use of electrical stimulation for pain is a cavalcade of research and innovation of many great scholars, scientists, and physicians over centuries that continues up to the present day. The legacy of this philosophy, research, and innovation is the field of neuromodulation for pain control. Today, patients with chronic pain from damage to the nervous system and chronic pain of the extremities, the axial low back, and neck, the face, and the viscera, all derive benefit from these early pioneers that have led to the expanding field of neuromodulation ... "on the shoulders of giants." We present here a history of the understandings of pain from the ancients to the present, which has led to our understandings of the use of electricity to cure disease and release patients from their suffering, generating the new, exciting, and expanding field of neuromodulation.
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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.