Neuromodulation : journal of the International Neuromodulation Society
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Objectives. Post-herpetic neuralgia (PHN) is a painful complication of herpes zoster infection and a common cause of chronic severe pain in elderly and/or debilitated patients. Although a wide range of treatments have been tried, a substantial number of patients continue to experience pain which remains refractory to all therapies. Increasingly, studies have demonstrated that oral opioids can have a beneficial effect on neuropathic pain. ⋯ Patients most commonly reported improvement in the deep component of their pain, next allodynia, and less so superficial lancinating pain. Conclusions. In conclusion, while a complex therapy, long-term use of intrathecal opioids is well tolerated, doses are titratable, administration is safe, and may help relieve severe short- and long-term neuropathic pain in selected PHN patients. Whether the addition of newer investigational intrathecal agents could improve these results is yet to be determined.
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Objectives. The hypothesis of the study is that adding percutaneous tibial nerve neuromodulation (Urgent PC, Uroplasty Inc., Minneapolis, MN, USA) with pelvic floor muscle rehabilitation (Evadri System, Hollister Inc., Libertyville, IL, USA) is safe, and more successful than either therapy alone for the treatment of urge incontinence. Material and Methods. Two hundred and fifty-six female patients with urge incontinence or mixed incontinence were included in this investigation. Patients were treated sequentially (on the same day) with both pelvic floor muscle rehabilitation and percutaneous tibial nerve neuromodulation twice per week at the Southern Arizona Urogynecology Center, Tucson, Arizona. ⋯ The median follow-up is now 19 months. There were no adverse side events. Conclusions. Neuromodulation of the pudendal, hypogastric, and tibial nerves is a highly effective treatment for urge incontinence, and superior to either treatment alone by a factor of greater than two times (see Table 1). [Table: see text].
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Objectives. We submit a retrospective analysis of results of eight patients suffering from intractable pain of established or suspected thalamic origin. These patients were treated with spinal cord stimulation (SCS) in the cervical or dorsal cord. No patient was suffering pain from a complete hemibody or facial area. ⋯ Two patients had a further stroke: One died and one was cured from pain. Good-to-excellent results were attained in six patients; long-term good-to-excellent results were maintained in three patients. Conclusions. Despite previous adverse reports, certain cases of thalamic pain can be effectively alleviated through SCS.
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Introduction. Interventional pain management techniques require precise positioning of needles or electrodes, therefore fluoroscopic control is mandatory. This imaging technique does however not visualize soft tissues such as blood vessels. Moreover, patient and physician are exposed to a considerable dose of radiation. ⋯ Discussion. The experience with EM navigation acquired with the radiofrequency technique can be transferred to other interventional pain management techniques, for instance, for the placement of a neuromodulation electrode close to the Gasserian ganglion. Currently, research is ongoing to extend the software of the navigation station for spinal application, and to adapt neurostimulation hardware to the EM navigation technology. This technology will allow neuromodulation techniques to be performed without x-ray exposure for the patient and the physician, and this with the precision of CT/MR imaging guidance.