Neuromodulation : journal of the International Neuromodulation Society
-
Spinal cord stimulation (SCS) was an outgrowth of the well-known gate control theory presented by Melzack and Wall in 1965. Although the method has been used to treat chronic severe pain for more than three decades, very little was known about the physiological and biochemical mechanisms behind the beneficial effects until recently. We now know that SCS activates several different mechanisms to treat different types of pain such as neuropathic and ischemic. ⋯ The anti-ischemic effect of SCS in angina pectoris due to intermittent coronary ischemia probably occurs because application of SCS appears to result in a redistribution of cardiac blood supply, as well as a decrease in tissue oxygen demand. Recent studies indicate that SCS modulates the activity of cardiac intrinsic neurons thereby restricting the arrythmogenic consequences of intermittent local coronary ischemia. The present state of knowledge is briefly reviewed and recent research directions outlined.
-
Objective. Since 1996 we have placed temporary catheters at the cervical nerve roots in chronic pain patients for the treatment of radiculopathy and complex regional pain syndrome. We investigated the possibility of placing electrodes both at the cervical spinal nerve and dorsal root ganglion for the purpose of neuromodulation. ⋯ Conclusions. In human cadavers, a percutaneous technique was successful in the placement of neurostimulator electrodes at the cervical and upper thoracic nerve roots using a novel trans-spinal approach. New smaller electrode systems that can be placed in a transforaminal position safely may be needed.
-
Objective. To present a novel approach for treatment of intractable occipital neuralgia using percutaneous peripheral nerve electrostimulation techniques. Methods. ⋯ The 13th patient (first in the series) was subsequently explanted following symptom resolution. Conclusions. In patients with medically intractable occipital neuralgia, peripheral nerve electrostimulation subcutaneously at the level of C1 appears to be a reasonable alternative to more invasive surgical procedures following failure of more conservative therapies.