Neuromodulation : journal of the International Neuromodulation Society
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This is a prospective case-control study that was conducted to determine if the addition of intraoperative powdered vancomycin placed directly into the wounds at the time of closure might decrease the rate of acute postoperative infection after the placement of spinal cord stimulator paddle leads. ⋯ This study indicates that intraoperative powdered vancomycin placed directly into the wounds at the time of closure can produce similar infection rates between the groups of patients requiring a laminectomy vs. a laminotomy for implantation of a thoracic paddle lead. These findings need confirmation by a randomized controlled design study.
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Since 1980, about 95,000 intrathecal (IT) drug delivery pumps have been implanted for the administration of a variety of opioid and non-opioid agents for neuropathic and nociceptive pain patients. IT granuloma in chronic opioid infusion is becoming less rare as an adverse effect of IT therapy and has been associated with many analgesic infusion agents. ⋯ CSF analysis should be performed in patients chronically treated by IT infusion who develop a rapid increase in pain with or without neurological deficits. A switch to ziconotide can be an option in patients without neurological signs. Further studies are needed to determine the relationship between granuloma formation and CSF reaction.
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Models that simulate clinical conditions are needed to gain an understanding of the mechanism involved during spinal cord stimulation (SCS) treatment of chronic neuropathic pain. An animal model has been developed for continuous SCS in which animals that have been injured to develop neuropathic pain behavior were allowed to carry on with regular daily activities while being stimulated for 72 hours. ⋯ A continuous SCS model has been developed. Animals with neuropathic pain behavior that were continuously stimulated showed significant increase in withdrawal thresholds proportional to stimulation time.
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The aim of this review is to make specialists in a variety of disciplines familiar with basic aspects of spinal cord stimulation and the role of mathematical modeling in understanding its mechanisms of action and the solution of basic problems. ⋯ In particular the conclusions from several computer simulation studies are relevant and of interest to specialists in many disciplines.
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Neurostimulation is one manifestation of neuromodulation of the gastrointestinal (GI) tract. This manuscript reviews the history of neurostimulation of the GI tract with emphasis on current methods of stimulation. ⋯ GI neurostimulation, as a type of neuromodulation, has been demonstrated to function at several locations in the GI tract for a variety of disorders. The future of neurostimulation in the GI tract will likely be influenced by a better understanding of pathophysiology as well as the development of new techniques and devices for neuromodulation.