Neuromodulation : journal of the International Neuromodulation Society
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Objectives. Newly developed bidirectional modulated sine waves (BMW) might provide some derived benefit to patients with low back pain. Pain relief by transcutaneous electric nerve stimulation (TENS) with BMWs was tested. Materials and Methods. Analgesic effects of BMWs and conventional bidirectional pulsed waves on chronic back pain in 28 patients were compared, and effects of repeated TENS using BMWs on chronic back pain were investigated in 21 patients by means of a randomized double-blind, sham-controlled, parallel-group method. ⋯ Weekly repeated treatments using massage and TENS with BMWs for 5 weeks resulted in a decrease of NRS, but there were no significant differences between the TENS plus massage and sham TENS plus massage groups. Conclusions. This study shows that TENS with BMWs significantly inhibits chronic back pain, and treatment effects are attained within a day. The results also suggest that there were no statistically significant long-term effects of TENS with BMW in the repeated treatment.
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Spinal cord stimulation (SCS) is an effective technique for the relief of neuropathic pain. Biologic complications are more prevalent within the first 3 months after implantation, are generally minor and reversible, and do not affect patients' acceptance of the treatment. Technically, hardware-related complications are uncommon and occur more frequently in the first 2 years following implantation of the device than after. ⋯ Areas covered by this article include patient positioning, the appropriate use of imaging, insertion of percutaneous and surgical leads, intraoperative stimulation, lead choice and suturing, considerations pre- and postimplantation, stimulation settings and regimens, implantable pulse generator positioning, and control of infections. It is hoped that these guidelines may help physicians to improve their SCS implantation technique and thereby improve the outcomes of the therapy. These guidelines should be of special value for newer centers starting SCS therapy for their patients.
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Objectives. This pilot study aims to validate the hypothesis that a smaller distance between spinal cord stimulation (SCS) lead and spinal cord results in more extensive paresthesia and less energy consumption. Materials and Methods. After insertion of a percutaneous SCS lead in patients with chronic pain (condition A), a first catheter was temporarily placed alongside the lead (condition B), and a second catheter was placed on the other side of the lead (condition C). ⋯ Results. Paresthesia coverage in all six patients was increased markedly in condition C when compared to condition A, whereas the mean values of PT, MC, and therapeutic range (MC/PT) dropped by 22%, 14%, and 13%, respectively. Conclusions. The results suggest that paresthesia coverage is increased when the space between the SCS lead and spinal cord gets smaller, whereas PT and energy consumption are reduced.
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Objectives. To examine the effect of using a common peroneal stimulator on an even and an uneven surface, and to compare measures with perceived response to stimulation. Method. Participants had a drop-foot caused by a stroke (N = 13) or multiple sclerosis (N = 7) and had used a common peroneal stimulator for > 3 months prior to the study. Walking speed and physiological cost index (PCI) were recorded under four conditions: with and without stimulation over an even and an uneven surface. ⋯ A correlation between perceived benefit of stimulation and a measured decrease in PCI was detected. Conclusion. Stimulation may be particularly beneficial for the more difficult task of walking on an uneven surface. Perceived benefit was related to a reduction in effort of walking, not in increased speed.
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Objectives. To investigate the nature of the force-velocity relationship on muscle forces and power outputs during functional electrical stimulation (FES)-evoked cycling at different pedaling cadences. Materials and Methods. Ten patients with T4-T9 spinal cord injuries (ASIA A) performed FES-evoked cycling at 50 rev/min using a motorized isokinetic ergometer for 20 min, after which quadriceps crank torque and power were measured at 10, 30, and 50 rev/min. Results. Pedal cadence affected both the shape and the magnitudes of the quadriceps torque and power curves. ⋯ At the higher cadences, peak torque and peak power were developed at significantly later angles (p < 0.001). Conclusions. The force-velocity relationship of muscle has a significant effect upon the muscle forces produced during FES-evoked cycling. However, muscle force rise times and fatigue within FES-evoked contractions, especially at a low cadence, should be considered when making comparisons between different FES-cycling cadences.