Pain
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In a prospective open study we tested the Edmonton injector (EI), a device designed by our group for subcutaneous injection of narcotics. In 25 patients, the EI was used for patient-controlled analgesia (PCA); mean duration of treatment was 28 +/- 10 days. Mean equivalent daily dose of morphine was 160 +/- 85 mg. ⋯ Narcotics were administered every 4 h and extra doses were administered on a 'PRN' basis. Waiting time for a 'PRN' dose in 8 patients before starting the EI was 18 +/- 7 min; after the EI was started, it was 3 +/- 4 min (P less than 0.01). We conclude that the EI is safe, effective and inexpensive, and that it will be particularly useful in smaller hospitals and developing countries.
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Spinal cord stimulation has evolved over the past 20 years into an easily implemented technique, with low morbidity, for the treatment of intractable, chronic pain in properly selected patients. We report our experience with a series of 62 patients implanted between 1983 and 1987, with percutaneous and laminectomy electrodes, and with single- and "multi-channel" (programmable, multi-contact) devices. Fifty had chronic, intractable low back and leg pain ("failed back surgery syndrome," lumbar arachnoid fibrosis), five had spinal cord injuries, and seven "peripheral" pathology or stump pain. ⋯ Univariate and multivariate analysis of patient characteristics and technical factors as predictors of outcome demonstrated significant advantages for female patients, and for patients implanted with "multi-channel" devices. With these devices, electrode geometries with central cathode(s) flanked by rostral and caudal anode(s) were favored disproportionately. Technical improvements in implanted spinal cord stimulation devices, in particular the development of multi-contact percutaneous electrode arrays and supporting programmable electronics, have significantly improved clinical results.