Neuromodulation : journal of the International Neuromodulation Society
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The human soleus muscles are essential for maintaining cardiac output during upright posture, but age and disuse lead to soleus atrophy, causing numerous health complications in older adults. Here, we investigate the influence of plantar nerve stimulation on soleus muscle activity focusing on ways exogenous stimulation technology can be optimized for the rejuvenation of the soleus muscles. ⋯ MMG analysis provides a sensitive and quantitatively reproducible assessment that has confirmed the ability of plantar nerve modulation to enhance soleus muscle performance in both the short and long term. Because soleus atrophy in older adults leads to numerous detrimental health conditions in these adults, the ability to rejuvenate the soleus muscles through simple, noninvasive, nerve modulation therapy supports use of this strategy as an effective clinical intervention. Results obtained here also indicate that MMG can play an important role in optimizing nerve modulation strategies in this application area.
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Initial deep brain stimulation (DBS) programming using a monopolar review is time-consuming, subjective, and burdensome. Incorporating neurophysiology has the potential to expedite, objectify, and automatize initial DBS programming. We aimed to assess the feasibility and performance of clinically implemented sensing-based initial DBS programming for Parkinson's disease (PD). ⋯ This study shows that sensing-based initial DBS programming for PD is feasible and rapid, and selected clinically effective contacts in most patients, including those with tremor. Technologic innovations and practical developments could improve sensing-based programming.
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Chronic pancreatic pain is one of the most severe causes of visceral pain, and treatment response is often limited. Neurostimulation techniques have been investigated for chronic pain syndromes once there are pathophysiological reasons to believe that these methods activate descending pain inhibitory systems. Considering this, we designed this systematic literature review to investigate the evidence on neuromodulation techniques as a treatment for chronic pancreatic pain. ⋯ The neuromodulation techniques of rTMS and SCS showed the most consistent potential as a treatment method for chronic pancreatic pain. However, the studies have notable limitations, and SCS has had no clinical trials. For VNS, we have two RCTs that showed a non-statistically significant improvement; we believe that both studies had a lack of power issue and suggest a gap in the literature for new RCTs exploring this modality. Additionally, tDCS and TENS showed mixed results. Another important insight was that opioid intake decrease is a common trend among most studies included and that adverse effects were rarely reported. To further elucidate the potential of these neurostimulation techniques, we suggest the development of new clinical trials with larger samples and adequate sham controls.
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Review
Socioeconomic Determinants of Initiating Neuromodulation for Chronic Pain: A Systematic Review.
Neuromodulation is an effective treatment for chronic pain; however, socioeconomic differences may influence decision-making to initiate this therapy. This review investigated potential differences in accessibility of neuromodulation for patients with chronic pain due to socioeconomic determinants. ⋯ Although neuromodulation was accessible for patients with varying levels of socioeconomic determinants, disparities were noted. When comparing the socioeconomic profiles of patients who receive neuromodulation and those who do not, education levels differ. Health-related inequality should be carefully monitored in chronic pain management with neuromodulation to ensure that potential disparities do not increase.