Neuromodulation : journal of the International Neuromodulation Society
-
Objective. This descriptive study compares outcome measures of a computerized assessment of pain, emotional distress, and quality of life between chronic noncancer pain patients who have received an implantable device (spinal cord stimulator or intrathecal pump; N = 143) and those who have not received a device (N = 130). Methods. Each patient marked the location of their pain on a body diagram and rated pain intensity, emotional distress, and impact of their pain on mood, sleep, and quality of life using a computerized pain assessment program. An electronic version of the Hospital Anxiety and Depression Scale (HADS) also was administered. ⋯ The patients with implantable devices also scored lower on the HADS Depression Subscale. Conclusion. The results suggest that although patients with an implantable device seem to have more pathology and greater disability, they report less emotional distress and improved quality of life compared with patients with chronic pain without an implantable device. Future controlled trials are needed to establish the role that an implantable device plays in improving mood and quality of life.
-
Objectives. This study is to evaluate long-term lead failure in spinal cord stimulation. Materials and Methods. One hundred and seven patients with permanently implanted spinal cord stimulators were studied for 14 years. All suspected paddle-lead failures were studied prospectively using preoperative radiography and intraoperative electric interrogation. ⋯ The mean time to primary lead failure was 37.9 months and to recurrent lead failure was 23.7 months. Conclusion. The incidence of primary lead failure remains low at 14.9% in the long run, but it is a significant adverse risk factor for recurrent paddle-lead failure. Great care should be undertaken to prevent lead failures by appropriate anchoring.
-
Two cases of chronic pelvic pain of unknown etiology with symptoms referable to the low abdominal wall are presented. These patients are often difficult to manage because of multiple causes and multiple pathways for pain transmission from the pelvis. ⋯ The patients reported excellent relief of their chronic pelvic pain. The use of neuromodulation via peripheral stimulation deserves further investigation as an alternative to spinal cord stimulation for chronic pelvic pain.
-
Neuropathic facial pain often is a very difficult problem to treat. We describe three cases of intractable neuropathic facial pain which were successfully treated with peripheral stimulation. These three cases review trialing, operative considerations, including cosmetic considerations, and provide some insight into the pathophysiology of these pain syndromes.
-
Objectives. The aims of this study were to clarify the direction and degree of brain shift, and to determine the predictive factors for a brain shift during deep brain stimulation (DBS) of the subthalamic nucleus (STN). Materials and Methods. To evaluate the brain shift during bilateral STN-DBS, the position of the anterior commissure (AC), posterior commissure (PC), midcommissure point (MC), and tip of the frontal lobe and anterior horn of the lateral ventricle were calculated pre- and poststereotactic operations in the three-dimensional direction employing special software (Leksell SurgiPlan). To determine the predictive factors for a brain shift, patient's age, operation hours, width of the third ventricle, bicaudate index (BCI), and cella media index (CMI) were compared with the shift of MC. ⋯ Among the predictive factors examined, namely, the patient's age, operation hours, width of the third ventricle, BCI, and CMI, only the CMI showed a correlation with the shift of the MC (r = 0.42, p < 0.01, Pearson's correlation coefficient; and p < 0.05, logistic regression analysis). Conclusions. In bilateral STN-DBS, brain shift occurred mainly in the posterior direction, and the CMI is useful for the prediction of a brain shift. Enlargement of the body part of the lateral ventricle is the most reliable factor for predicting a brain shift.