Neuromodulation : journal of the International Neuromodulation Society
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Observational Study
Cervical Spinal Cord Stimulation Using Monophasic Burst Waveform for Axial Neck and Upper Extremity Radicular Pain: A Preliminary Observational Study.
Cervical spinal cord stimulation (cSCS) is an accepted therapeutic option for radicular upper extremity pain and less commonly for cervical axial pain despite less available literature in comparison with lumbar and lower extremity applications. ⋯ This preliminary study suggests that the use of the burst waveform applied to cSCS results in improved function and decreased pain scores in subjects with axial neck pain with and without radicular symptomatology and cervicogenic headache.
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Burst and high-frequency spinal cord stimulation (SCS), in contrast to low-frequency stimulation (LFS, < 200 Hz), reduce neuropathic pain without the side effect of paresthesia, yet it is unknown whether these methods' mechanisms of action (MoA) overlap. We used empirically based computational models of fiber threshold accommodation to examine the three MoA. ⋯ The model, based on empirical data, predicts that, at clinical amplitudes, burst and high-frequency SCS do not activate large-diameter fibers that produce paresthesia while driving medium-diameter fibers, likely different from LFS, which produce analgesia via different populations of dorsal horn neural circuits.
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Randomized Controlled Trial Multicenter Study
Cost-Effectiveness Analysis of Peripheral Nerve Field Stimulation as Add-On Therapy to Spinal Cord Stimulation in the Treatment of Chronic Low Back Pain in Failed Back Surgery Syndrome Patients.
Presently, there is only limited evidence about the cost-effectiveness of peripheral nerve field stimulation (PNFS) and no evidence to date on the cost-effectiveness of PNFS as an add-on therapy to spinal cord stimulation (SCS). In a multicenter randomized controlled trial, PNFS as add-on therapy to SCS demonstrated clinical effectiveness in treating chronic low back pain in failed back surgery syndrome (FBSS) patients. We report here the cost-effectiveness of PNFS as additional therapy. ⋯ From a Dutch national health-care context, when the willingness to pay threshold is up to 60.000 Euros per QALY, PNFS as an add-on therapy to SCS for the treatment of low back pain in FBSS patients has a high probability of being cost-effective.