Neuromodulation : journal of the International Neuromodulation Society
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Introduction. Intractable pain in the affected arm is a common sequel to severe traction lesions of the brachial plexus. Its management presents a challenge. Existing interventional therapies are not effective for the intractable pain from brachial plexus traction lesions, in the long term. ⋯ Methods. We report here a single case report of the successful management of intractable pain of uncertain pathology following traction injury of the shoulder and brachial plexus with the percutaneous implantation of a permanent stimulating electrode via a stimulating needle to the brachial plexus using the posterior route at the interscalene level. Results. Stimulation of the brachial plexus in this one patient has resulted in excellent pain control and unexpected beneficial sensory and motor changes in the arm of the patient. Conclusions. We cautiously conclude that percutaneous implantation of a stimulating electrode to the brachial plexus via a stimulating needle is a relatively simple procedure when compared to surgical implantation and, as shown in our case, very effective.
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Objective. When using spinal cord stimulation (SCS) for chronic pain management, precise longitudinal positioning of the cathode is crucial to generate an electrical field capable of targeting the neural elements involved in pain relief. Presently used methods have a poor spatial resolution and lack postoperative flexibility needed for fine tuning and reprogramming the stimulation field after lead displacement or changes in pain pattern. We describe in this article a new method, "electrical field steering," to control paresthesia in SCS. ⋯ Conclusions. By means of cathodal steering on a longitudinal contact array, the group of excited DC and DR fibers, and thus paresthesia coverage, can be controlled when using SCS. With widely spaced contacts, superposition of the electrical field from each steering contact is limited. To precisely control segmental paresthesia (DR stimulation), a small contact spacing is necessary.
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Background. Lyme disease is caused by Borrelia, a bacterium transmitted by the bite of a deer tick. A slow developing encephalopathy or an axonal polyneuropathy with distal paresthesia and spinal or radicular pain rarely occurs and can be hard to treat. ⋯ Results. After 18 months of therapy and follow-up, this patient's analgesia, as a result of SCS, continues to be excellent, with almost complete subjective pain relief and cessation of adjuvant analgesic medication. Conclusions. SCS may be efficacious for the treatment of neuropathic pain due to Lyme disease.
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Objectives. Spinal cord stimulation has been used extensively for failed back surgery syndrome, although dominant axial low back pain is difficult to treat effectively with this modality. The use of a surgically placed, double, quadripolar lead may result in better paresthesia of the low back, therefore enhancing outcomes in this difficult to treat population. Materials and Methods. Accordingly, this prospective study was designed to assess the effectiveness of placing such a lead at the T8-T10 level under general anesthesia without intraoperative testing for concordancy of paresthesia distribution. ⋯ The ability to lead a more active and social life was increased and 85% of patients said they would undergo spinal cord stimulation again. Placing the lead higher in the spinal canal (T8) resulted in a tendency for better paresthesia coverage of the low back when compared to lower lead placements. Conclusions. Placing a double quadripolar paddle lead under general anesthesia resulted in good clinical outcome similar to other implant techniques.