Neuromodulation : journal of the International Neuromodulation Society
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Objectives. In Europe, patients with acute pelvic pain are transported to the hospital in an ambulance without an emergency physician. We hypothesized that transcutaneous electrical nerve stimulation (TENS) would be an effective noninvasive procedure for pain treatment. Methods. We conducted a prospective, randomized, blinded study where 100 women were randomly assigned into a real- or a sham-TENS group. ⋯ Results. Compared to sham TENS, patients with active TENS felt that their pain was reduced by half after treatment (p < 0.01), anxiety scores significantly decreased (p < 0.01), heart rate and arteriolar vasoconstriction decreased significantly (p < 0.01), and nausea (p < 0.01) was lessened. Overall satisfaction with the received care was significantly higher (p < 0.01). Conclusion. TENS is a safe, rapid, and effective analgesic treatment for acute pelvic pain.
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Objective. The safety and efficacy of intrathecal (IT) ziconotide was studied in a randomized, double-blind, placebo-controlled trial. Materials and Methods. Patients (169 ziconotide, 86 placebo) with severe chronic nonmalignant pain unresponsive to conventional therapy and a visual analog scale of pain intensity (VASPI score) ≥ 50 mm were treated over a 6-day period in an inpatient hospital setting. Initial starting dose was 0.4 µg/hour and was titrated to analgesia or intolerance (maximum dose 7.0 µg/hour). ⋯ During the initial titration phase, a significantly greater percentage of patients in the ziconotide group compared to the placebo group reported AEs, including abnormal gait, amblyopia, dizziness, nausea, nystagmus, pain, urinary retention, and vomiting. Conclusion. Ziconotide provided significant analgesia in patients for whom conventional therapy failed. However, there was a considerable incidence of ziconotide-associated AEs due to the rapid titration and high doses administered.
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Objectives. To determine whether deep brain stimulation is an effective treatment for neuropathic pain of varied etiology. Material and Methods. Thirty-four patients with intractable neuropathic pain were prospectively studied using visual analog scores, McGill Pain Questionnaire, and Quality of Life Questionnaires (EUROQOL EQ-5D VAS, and SF-36 v-2). Patients had either deep brain stimulation of either the periventricular gray or ventroposterolateral nucleus of the thalamus, or both. ⋯ Health-related quality of life improved by 38%. Conclusions. Deep brain stimulation is an effective treatment for neuropathic pain. The factors that influence outcome, including etiology and site of stimulation, are discussed.
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Objectives. With respect to postoperative activities of daily living (ADL), we retrospectively investigated associated psychiatric symptoms that influenced beneficial effects of subthalamic nucleus (STN) stimulation in our Japanese patients with Parkinson disease (PD). Materials and Methods. Twenty-five patients underwent bilateral STN stimulation. Pre- and 3 months after the surgery, their parkinsonian symptoms were evaluated with Unified Parkinson Disease Rating Scale (UPDRS) and Schwab-England (S-E) ADL scale. ⋯ Preoperative score for intellectual impairment was only a significant predictor of worse postoperative ADL in "off" state. Conclusions. The markedly lower dose of levodopa may suggest ethnic characteristics of our Japanese patients with respect to tolerance for antiparkinsonian medications. Preoperative manifestation of drug-induced psychosis and cognitive dysfunction were the major factor that strikingly suppressed daily activities after STN stimulation.