Articles: neuralgia.
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Spinal cord stimulation (SCS) is a treatment for chronic neuropathic pain. It is based on the delivery of electric impulses to the spinal cord, traditionally in a regular square-wave pattern ("tonic" stimulation) and, more recently, in a rhythmic train-of-five "BurstDR" pattern. The safety of active SCS therapy in pregnancy is not established, and recommendations are based on limited casuistic evidence. We present in this study clinical data on a case series of six women treated with burst SCS during pregnancy. In addition, we present the ultrasonographic flow measurements of fetal and uteroplacental blood flow in a pregnant patient. ⋯ The data presented in this study add to the accumulating evidence of the safety of SCS in pregnancy.
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Rev Assoc Med Bras (1992) · Jan 2023
Does the presence of radiculopathy affect sleep quality and lower extremity functionality in neuropathic low back pain?
Sleep disturbance in chronic neuropathic low back pain is a well-known condition. In this study, we aimed to investigate the effect of lumbar radiculopathy on sleep quality and lower extremity functionality in the presence of neuropathic low back pain. ⋯ We found that the presence of radiculopathy did not affect sleep quality and lower extremity functionality in disk herniation patients with neuropathic pain. Although it was not statistically significant in our study, we think that the degree of herniation may affect sleep and lower extremity functionality rather than the number of disk herniation levels with the available data. The fact that neuropathic pain is not limited to disk herniation and radiculopathy, and that neuropathic pain is intertwined with clinical conditions such as anxiety, sleep disorders, and depression are among the conditions that make the studies difficult.
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Background: Trigeminal nerve injury causes orofacial pain that can interfere with activities of daily life. However, the underlying mechanism remains unknown, and the appropriate treatment has not been established yet. This study aimed to examine the involvement of interferon gamma (IFN-γ) signaling in the spinal trigeminal caudal subnucleus (Vc) in orofacial neuropathic pain. ⋯ IONI significantly enhanced the neuronal activity of the mechanical-evoked responses, and administration of an IFN-γ antagonist significantly inhibited these enhancements. Conclusions: IFN-γ signaling through the receptor in astrocytes is a key mechanism underlying orofacial neuropathic pain associated with trigeminal nerve injury. These findings will aid in the development of therapeutics for orofacial neuropathic pain.
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Randomized Controlled Trial
Does a Screening Trial for Spinal Cord Stimulation in Patients With Chronic Pain of Neuropathic Origin Have Clinical Utility (TRIAL-STIM)? 36-Month Results From a Randomized Controlled Trial.
Screening trials before full implantation of a spinal cord stimulation device are recommended by clinical guidelines and regulators, although there is limited evidence for their use. The TRIAL-STIM study showed that a screening trial strategy does not provide superior patient pain outcome at 6-month follow-up compared with not doing a screening trial and that it was not cost-effective. ⋯ The long-term results show no patient outcome benefit in undertaking an SCS screening trial.