Neurosurgery clinics of North America
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Chronic pain impairs the quality of life for millions of individuals and therefore presents a serious ongoing challenge to clinicians and researchers. Debilitating chronic pain syndromes cost the US economy more than $600 billion per year. This article provides an overview of the epidemiology, clinical presentation, and treatment outcomes for craniofacial, spinal, and peripheral neurologic pain syndromes. Although the authors recognize that the diagnosis and treatment of the chronic forms of neuropathic pain syndromes represent a clinical challenge, there is an urgent need for standardized classification systems, improved epidemiologic data, and reliable treatment outcomes data.
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The microvascular decompression procedure has proven to be a safe and effective option in the surgical management of neurovascular compression syndromes in general and trigeminal neuralgia in particular. This article aims to serve as an overview of the decision-making process, application of the surgical technique, and clinical outcome pertaining to this procedure.
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Chronic pain is a complex disorder with extensive overlap in sensory and limbic pathways. It needs systemic therapy in addition to focused local treatment. This article discusses treatment modalities other than surgical and interventional approaches and also discusses the literature regarding these treatment modalities, including pharmacotherapy, physical and occupational therapy, psychological approaches including cognitive behavior therapy, and other adjunctive treatments like yoga and tai chi.
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Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes.
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Neurosurg. Clin. N. Am. · Oct 2014
ReviewIntrathecal pain pumps: indications, patient selection, techniques, and outcomes.
Intrathecal drug delivery represents an advanced modality for refractory chronic pain patients as well as intractable spasticity. This article reviews the advantages and indications for intrathecal therapy, as well as recommendations for proper patient selection using a multidisciplinary team to provide a global assessment of the impact of chronic pain on the patient's well-being. The goals and expectations of trialing are discussed alongside advantages and disadvantages of several trialing techniques. A discussion of outcomes is presented for patients with chronic pain due to both malignant and nonmalignant causes.