Neuromodulation : journal of the International Neuromodulation Society
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The objective of this study was to compare the cost and safety of intrathecal injection (IN) vs. epidural infusion (CE) trial and to provide a preliminary assessment of the prognostic value of each in the selection of patients for long-term continuous intrathecal opioid therapy (CIOT). Thirty-seven patients with chronic nonmalignant pain who were being considered for CIOT were randomized to morphine trial by IN or CE. Analgesic response and complications were monitored throughout trial. ⋯ There was no difference between IN and CE groups in McGill Pain rating, quality of life (VAS), mood (Profile of Mood States), or function (Sickness Impact Profile) after six months of CIOT. We conclude that intrathecal injection is a safe procedure for use in selection of patients for CIOT and is less costly than epidural infusion. Differences in pain and functional response to long-term opioids among patients selected by either trial method are not large.
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Little is known of the events that initiate the adaptive response of skeletal muscle to a sustained change in use. This study was designed to distinguish between the role of the electrical activity pattern and that of the resulting contractile force in driving different aspects of the response. A better understanding of these issues would lead to improved clinical protocols for functional electrical stimulation. ⋯ The optimized pattern maintained muscle bulk more effectively. We conclude that changes in myosin isoform composition and fatigue resistance are driven by aggregate impulse activity. Changes in Ca(2+) transport and muscle bulk show a distinct pattern dependence.
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While spinal cord stimulation has commonly been carried out using percutaneous leads, these devices have limitations in cervical implants due to problems with positional stimulation and lead migration. Paddle leads, by virtue of their design, are more stable in their apposition to the neural elements; however, mid and lower cervical insertions have been associated with both acute and subacute spinal cord injuries. These complications are likely related to limitations in canal diameter, as paddle leads occupy a greater volume than percutaneous leads. ⋯ No patient suffered neurologic sequelae as a result of this procedure. We have found C1-C2 sublaminar insertions of paddle leads to be a safe and effective way of treating neuropathic pain phenomenon involving the upper extremity. To further assess the relative benefit over percutaneous leads, a prospective trial would be required.
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The objective of this study was to evaluate the effect of automatic event-driven electrical stimulation on the dorsal penile/clitoral nerve for management of neurogenic detrusor overactivity in spinal cord injured subjects. In order to reach the objectives it was necessary to design and realize a portable device for ambulatory urodynamic studies which was able to activate an electrical stimulator when the detrusor pressure exceeded a certain threshold. ⋯ In testing the automatic event-driven system in the spinal cord injured subject, detrusor contractions were successfully inhibited until a certain bladder volume was reached and no incontinence episodes were observed prior to disabling the system. The preliminary results indicate that automatic event-driven electrical stimulation on the dorsal penile/clitoral nerve can inhibit involuntary detrusor contractions in spinal cord injured subjects and hereby restore continence and increase bladder capacity.