Neuromodulation : journal of the International Neuromodulation Society
-
Neuropathic pain is difficult to manage and treat. Spinal cord stimulation (SCS) has become an established procedure for treating chronic neuropathic pain that is refractory to pharmacological therapy. In order to achieve better analgesia, a number of studies have evaluated the effectiveness of combining drug therapy with SCS. Cholecystokinin antagonists, such as proglumide, enhance the analgesic efficacy of endogenous opioids in animal models of pain. We previously reported that both systemic and spinal administration of proglumide enhances analgesia produced by both low- and high-frequency transcutaneous electrical nerve stimulation (TENS). Since SCS produces analgesia through endogenous opioids, we hypothesized that the analgesic effect of SCS would be enhanced through co-administration with proglumide in animals with neuropathic pain. ⋯ Proglumide may be a candidate for achieving analgesia for patients with refractory neuropathic pain conditions, but does not enhance analgesia produced by SCS.
-
Comparative Study
Transcutaneous Recharge: A Comparison of Numerical Simulation to In Vivo Experiments.
Numerical simulation and animal experiments quantified tissue temperatures during the transcutaneous recharge of neuromodulation implants. The temperature results were used to determine the likelihood of tissue injury in humans. ⋯ The numerical simulation predicts tissue temperatures during transcutaneous recharge of implants. Results show that the implant depth does not have a large impact on the tissue temperatures and thermal exposures are sufficiently low so that they are unlikely to have any physiologic consequence.
-
To investigate the effect of a quality improvement project that resulted in an infection control bundle to reduce the number of spinal cord stimulator (SCS) infections. ⋯ Multidisciplinary measures to reduce SSIs reduced the number of SCS associated infections in our study setting.
-
Review Case Reports
Dual Anchor Internal Pulse Generator Technique May Lower Risk of Twiddler's Syndrome: A Case Series and Literature Review.
Twiddler's syndrome (TS) is described as a spontaneous rotation or intentional external manipulation of implanted internal pulse generator (IPG) for neurological or cardiac disorders. There have been identified some predisposing factors of the development of TS such as: loose subcutaneous tissue, older age of individuals undergoing deep brain stimulation (DBS) procedures, creation of too large pockets for IPG. Apart from these factors, the construction of IPG itself may predispose to the development of TS. ⋯ Our case series suggests that a predisposing factor of TS may also be the construction of IPG itself (a single anchoring hole intended for fixation), which naturally represents less fixation of the IPG to the fascia or muscle in the subcutaneous pocket. In this preliminary report we present suggestions to lower the risk of TS, including using dual anchor capable IPGs, reducing pocket volume and using nonabsorbable suture.
-
Multicenter Study
Multicenter Retrospective Study of Neurostimulation With Exit of Therapy by Explant.
Spinal cord stimulation (SCS) devices are cost effective and improve function as well as quality of life. Despite the demonstrated benefits of SCS, some patients have the device explanted. We are interested in exploring the patient characteristics of those explanted. ⋯ SCS is largely a safe and efficacious strategy for treating select chronic refractory pain syndromes. Further prospective data and innovation are needed to improve patient selection, maintain SCS therapeutic efficacy and reduce the reasons that lead to device explant.