Neuromodulation : journal of the International Neuromodulation Society
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Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). ⋯ EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.
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Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. ⋯ The identification of determinants for MCI is a challenge to improve the accuracy of prognostic models in SCS for patients with chronic pain. Our results, if confirmed in other populations with a larger sample size, have implications for patients with chronic pain who are candidates for SCS treatment.
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Placement of spinal cord stimulation (SCS) paddles under general anesthesia using intraoperative neuromonitoring (IONM) has been shown to be associated with equivocal or superior clinical outcomes in comparative studies. The value of IONM in percutaneous permanent SCS placement has not been demonstrated. ⋯ Permanent percutaneous implantation of a SCS system using IONM with general anesthesia demonstrates results within range to those in the literature. Patients demonstrated statistically significant improvement in outcomes and opioid use was reduced in 71% of patients who were using opioids at baseline. We recommend its use in patients with morbid obesity, sleep apnea, and considerable anxiety. Further research is warranted to define the possible future role for percutaneous SCS implantation under IONM.
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In spinal cord stimulation (SCS), the electrical stimulation of the spinal cord with an implanted lead evokes a tingling peripheral sensation known as paresthesias. Newer stimulation paradigms allow paresthesia-free treatment, but during the implantation of the lead, paresthesias must cover the painful area to achieve optimal treatment effect. The localization of the evoked paresthesias can be difficult to accurately describe for the patient, and furthermore depends on a complex and only partially predictable set of parameters that includes the anatomical localization and the programming of the electrical field. We aimed to optimize SCS implantation procedures by devising a way to aid the patient in making useful descriptions of the evoked paresthesias, then to visually convey the full set of information-anatomical position of the lead, programming parameters, and evoked paresthesias-directly to the implanting physician. ⋯ We present an Implanter's Integrated Information (I3) system; a simple, inexpensive solution for gathering, integrating, and conveying the complex set of information necessary for a successful SCS procedure.
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To date, clinical pain research has typically used subjective questionnaires to assess effectiveness of treatment. However, in the near future, new technologies may provide us objective outcome measures as an alternative to self-report. The goal of this study is to compare subjective and objective sleep assessments in a population of failed back surgery syndrome (FBSS) patients, treated with spinal cord stimulation (SCS). ⋯ The results about sleep measurements shown in this population of chronic pain patients, suggest that the subjective ratings scored worse than the objective measurements. Second, short-term SCS mainly seems to affect subjectively measured sleep parameters, especially SOL. This study shows the discrepancies between objective and subjective assessments in chronic pain research. Objective tools are indispensable for a correct assessment and treatment of sleep parameters. They are also playing a role as a biofeedback tool and are supporting the rehabilitation process.