Neuromodulation : journal of the International Neuromodulation Society
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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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This study aimed to assess the analgesic effect of kilohertz alternating current applied to the severed nerves in amputees afflicted by intractable limb pain. ⋯ This pilot study generated preliminary evidence on the efficacy and safety of kilohertz electrical nerve block for postamputation pain, justifying a pivotal study for regulatory approval.
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Although sleep disorder is one of the most serious comorbidities of refractory chronic pain, it is usually assessed only from the patients' subjective point of view. Therefore, we aimed to objectively evaluate the sleep efficiency of patients with chronic pain. ⋯ With the use of an actigraph, improvements in sleep of patients with chronic pain undergoing SCS were demonstrated. One case showing improvement in sleep despite pain palliation may suggest that SCS might have independently affected the sleep system, although further studies are necessary.
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Case Reports
Spinal cord stimulation for electrical storm refractory to conventional medical treatment: an emerging indication?
To observe the effect of thoracic spinal cord stimulation with dual octipolar epidural electrodes on episodes of ventricular tachycardia and ventricular fibrillation in a patient with nonischemic familial cardiomyopathy and severe electrical storm refractory to conventional medical treatment. ⋯ Spinal cord stimulation may play an important therapeutic role in the treatment of refractory electrical storm when conventional medical treatments have failed. The mechanism by which stimulation of the spinal cord confers a therapeutic effect is not completely understood, although direct modulation of sympathetic and parasympathetic tone in the cardiac conduction system is most likely, based on animal models of ischemia-induced ventricular tachycardia.
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Sacral neuromodulation (SNM) is theorized to alter the neural pathways that mediate bladder and urethral sensation. We hypothesize that SNM affects current perception thresholds (CPTs) of afferent sensory nerve pathways. ⋯ With a measurable change in CPT values for Aδ-fibers and Aβ-fibers, these findings suggest that SNM modulates large myelinated afferent fibers in the bladder. Notably, little or no changes were found in the C-fiber CPT measurements. More research is needed with a larger sample size to determine the significance of these findings.