Neuromodulation : journal of the International Neuromodulation Society
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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.
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Objective. To examine the importance of posture on the efficacy of spinal cord stimulation in a population of chronic pain patients previously implanted with a spinal cord stimulator. Materials and Methods. ⋯ The mean range and SD of stimulation required to achieve paresthesia at all three posture levels was found to be 0.113 ± 0.062 μC for leads in the cervical region (N = 11) and 0.494 ± 0.297 μC for leads in the thoracic region (N = 19). Conclusions. To provide adequate stimulation at all postures, multiple stimulation settings (programs) would be required.
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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.