Neuromodulation : journal of the International Neuromodulation Society
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Randomized Controlled Trial
A prospective, randomised, double-blind, placebo-controlled study to examine the effectiveness of burst spinal cord stimulation patterns for the treatment of failed back surgery syndrome.
Spinal cord stimulation (SCS) for the treatment of chronic pain is a well-established therapy. However, the requirement that paresthesia be continually felt by the patient has important downsides. This study evaluated the effectiveness of a new paresthesia-free SCS paradigm, called burst stimulation, for the treatment of failed back surgery syndrome (FBSS) with a prospective, randomized, double-blind, placebo-controlled design. ⋯ Overall, burst stimulation resulted in significantly better pain relief and improved pain quality in the short term compared with 500-Hz tonic stimulation and placebo stimulation and was preferred by the majority of patients.
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Direct testing of deep brain stimulation (DBS) mechanisms in humans is needed to assess therapy and to understand stimulation effects. ⋯ IPG replacement occurs when the DBS/brain interface is stable and patients demonstrate symptom reduction with known stimulation parameters. Conducting research at this time point avoids DBS implant issues, including temporary microlesion effects, fluctuating electrode impedances, and technical limitations of contemporary IPGs, providing advantageous conditions to conduct translational DBS research with minimal additional risk to research subjects.
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The application of transcranial static magnetic field stimulation (tSMS) in humans reduces the excitability of the motor cortex for a few minutes after the end of stimulation. However, when tSMS is applied in humans, the cortex is at least 2 cm away, so most of the strength of the magnetic field will not reach the target. The main objective of the study was to measure the strength and reproducibility of static magnetic fields produced by commercial neodymium magnets. ⋯ These measurements offer a quantitative empirical reference for developing devices useful for tSMS protocols in both humans and animals.
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In spinal cord stimulation, anodes tend to have a strong effect over the area of dorsal column (DC) activation, when configured as both longitudinal guarded cathodes (LGCs) and transverse tripoles (TTs). Inclusion of a small spacing step (LGC+) in the center-center (C-C) spacing of the LGC can be an efficient method to study the local effects around the electrode. The primary aim of this computer modeling study is to investigate if enhanced DC recruitment is achieved when anodal currents in TT and LGC combinations (both LGC and LGC+) are increased up to 30% with respect to the cathodal current. Secondly, the merits of anodal intensification (AI) are evaluated by comparing the DC recruitment areas (S(RA)) and energy consumption (EDT ) of LGC+ with AI, against stimulation using an LGC without AI. ⋯ AI of TTS is not advantageous. LGC and LGC+ with AI allow additional DC stimulation, which may increase the likelihood of activating fibers inaccessible with conventional programming. LGC+ with AI can be more efficient than LGCs without AI, as a larger SRA and UR is achieved at lower EDT .