Neuromodulation : journal of the International Neuromodulation Society
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Introduction. At the present time, there is no reliable method or drug for effective relief of the severe pain caused by the amyloldotic polyneuropathy (AP). Objective. ⋯ The patient had the IT treatment for 867 days, of which 777 days (> 90%) were spent at home. Conclusion. Long-term IT administration of opioid and bupivacaine provided satisfactory long-term pain relief in a patient with refractory pain due to AP.
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An intrathecal opioid infusion using an implanted programmable pump is frequently used for controlling refractory pain. Morphine, which is the only opioid presently approved by the FDA for use in such pumps, occasionally fails to work or is not tolerated by the patient; therefore other opioids are considered for infusions. When switching from one drug to another, it is important to consider not only equianalgesic dose conversions, but also lipophilicity. We report on three cases that demonstrate the need to use only a fraction of the equianalgesic dose when shifting from lipophilic to nonlipophilic opioids in such infusions.
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Objectives. Recent technical improvements in implanted stimulation devices, in particular the development of programmable, multicontact devices, have facilitated their clinical application in the management of pain. If the capabilities of these devices are to be used to full advantage, adjustment after implantation demands a major investment of time and effort. ⋯ Results and Conclusions. Our patient-interactive computerized system has proven to be safe and effective clinically in adjusting implanted spinal cord stimulators. It offers advantages of data standardization and quality control, as well as delivery of novel pulse sequences and protocols to assess the treatment of pain and neurological disorders by electrical stimulation devices.