Neuromodulation : journal of the International Neuromodulation Society
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Standard anterograde placement of a surgical paddle lead (SPL) for spinal cord stimulation (SCS) can be challenging in patients with scarring from prior spine surgery, instrumentation obstructing the targeted level, or severe stenosis below the targeted level. One potential alternative is retrograde (caudal) insertion by performing laminotomies cephalad to the targeted levels. The literature is limited to only a small number of individual cases describing this technique. In this report, the authors present their experience over the last ten years of the retrograde insertion of SPLs for SCS. ⋯ The retrograde insertion of SPLs is a low-risk and feasible procedure that can be performed with minimal risk of lead migration, fracture, or deep surgical site infection. The retrograde strategy can be used in SPL trials or permanent placements.
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This study aimed to investigate the analgesic effects of H-coil repetitive transcranial magnetic stimulation (rTMS) primarily targeting the hand area of the primary motor cortex (M1) in patients with peripheral neuropathic pain. Given that the H-coil has a wider reach than conventional coils, there is a possibility that targeting the hand motor cortex also may stimulate prefrontal areas. Thus, we also aimed to examine whether rTMS with an M1 target could produce effects on psychologic outcomes. ⋯ The Clinicaltrials.gov registration number for the study is NCT05488808.
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Patients with refractory chronic pain may be considered for spinal cord stimulation (SCS) as an interventional therapy. Studies have shown that psychiatric disorders are associated with worse outcomes. However, this relationship may not be understood by all healthcare professionals. Despite psychologic clearance and proper indication, pain medicine physicians often find themselves questioning the appropriateness of some candidates. The authors conducted a scoping review to identify assessments ascertaining patients with pronounced psychiatric burden that may complicate optimal response, to identify any clearly defined psychiatric contraindications, and to review ways psychiatric comorbidities may be addressed in patients at risk for suboptimal long-term response. ⋯ This review indicates a need for a standardized, evidence-based, algorithmic psychologic clearance protocol for SCS implantation. The authors designed such a protocol using multiple assessments targeted at establishing true contraindications and identifying barriers requiring further intervention to optimize outcomes, while ensuring individual accommodation.
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Spinal cord stimulation (SCS) therapy is an effective treatment for chronic pain, particularly in conditions such as postlaminectomy syndrome and complex regional pain syndrome (CRPS). Rare case reports described significant weight loss in patients who underwent dorsal column SCS therapy for chronic pain. Recently, neuromodulation for obesity has become a novel field for research. We aimed to investigate weight trends among patients treated with SCS for chronic pain. ⋯ Our findings suggest that SCS therapy may affect weight in patients with chronic pain. Further studies are needed to investigate the potential role of SCS in weight modulation.
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Raynaud's phenomenon (RP) is a vascular disorder characterized by episodic peripheral artery vasospasms, resulting in paleness, cyanosis, and/or erythema. There are few reports, mostly case reports, on the benefits of spinal cord stimulation (SCS) for the treatment of RP. However, there is a lack of objective evidence on SCS-induced modulation of the sympathetic system (eg, vasodilation) in this condition. We hypothesize that evoked compound action potential-controlled closed-loop SCS may relieve pain, reduce the severity and frequency of Raynaud attacks, and improve peripheral blood flow. ⋯ This pilot study offers evidence linking SCS with the activation of large, myelinated fibers within the dorsal column in patients with RP. This activation is associated with improvement in the number of patient-related outcomes and enhanced peripheral circulation.