Neuromodulation : journal of the International Neuromodulation Society
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Objective. In addition to treatment of refractory chronic pain in patients with peripheral vascular disease, dorsal spinal cord stimulation (DCS) increases cutaneous blood flow to the extremities and may have a limb-saving effect. The purpose of this study was to examine the role of the sympathetic nervous system in the cutaneous vasodilation due to DCS. ⋯ Propranolol (5 mg/kg, i.v.), a nonselective beta-adrenergic receptor antagonist, attenuated the DCS response while adrenal demedullation did not. Conclusion. Overall, our results show that DCS-induced vasodilation can occur through mechanisms that are independent of sympathetic outflow.
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This paper is an overview of the results of computer modeling of spinal cord stimulation, started ten years ago at the University of Twente, The Netherlands. Results are given of the analysis of various geometrical factors, including spinal anatomy, which influence the effect of spinal cord stimulation on nerve fiber recruitment and paresthesia coverage. ⋯ Two new electrode types are presented: the narrow bi-/tripole and the transverse tripole. The latter also enables adjusting the body area affected with paresthesia by means of a dual channel pulse generator giving simultaneous pulses, thereby limiting surgical interventions for electrode repositioning.
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Objectives. To test the efficacy and safety of intraspinal opioids for patients with nonmalignant pain. Design. ⋯ Conclusions. Long-term intrathecal opioids are efficacious, practical, and safe for the treatment of nonmalignant pain syndromes. FBSS patients respond similarly to intraspinal analgesia as the patients with neuropathic pain, while the group with mixed pain from other non-FBSS causes respond similarly to the nociceptive pain patients.
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Study Design. This is a prospective study designed to identify psychological factors associated with response to spinal cord stimulation (SCS) trial. Summary of Background Data. ⋯ Conclusions. Patient mood state is an important predictor of trial outcome. Specific indicators of SCS trial outcome are the MMPI depression and mania subscale scores with successful trials being associated with individuals who are less depressed and have higher energy levels.