Neuromodulation : journal of the International Neuromodulation Society
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While spinal cord stimulation (SCS) has established itself as an accepted and validated treatment for neuropathic pain, there are a number of conditions where it has experienced less, long-term success: post amputee pain (PAP) being one of them. Dorsal root ganglion (DRG) stimulation has shown great promise, particularly in conditions where traditional SCS has fallen short. One major difference between DRG stimulation and traditional SCS is the ability to provide focal stimulation over targeted areas. While this may be a contributing factor to its superiority, it can also be a limitation insofar stimulating the wrong DRG(s) can lead to failure. This is particularly relevant in conditions like PAP where neuroplastic maladaptation occurs causing the pain to deviate from expected patterns, thus creating uncertainty and variability in predicting targets for stimulation. We propose selective radiofrequency (RF) stimulation of the DRG as a method for preoperatively predicting targets for neuromodulation in patients with PAP. ⋯ Mapping the DRG via RF stimulation appears to provide improved accuracy for determining lead placement in the setting of PAP where pain patterns are known to deviate from conventional dermatomal mapping.
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Methods of energy delivery for traditional spinal cord stimulation (SCS) systems consist of adjusting programming parameters to affect the total charge delivered per unit time. One high electrical charge delivery method being considered is subthreshold high density (HD) programming. To date, there is limited clinical evidence for the efficacy and safety of paresthesia-free HD programming. The aim of this study was to examine the efficacy and safety of HD programming. ⋯ In subpopulations, HD programming may be a viable option to deliver subthreshold pain reduction. Randomized, controlled trials with extended follow-up are needed to further evaluate HD programming.
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We report the outcome of a consecutive series of 26 patients suffering from chronic medically-refractory neuropathic pain of the upper limb (including 16 patients with complex regional pain syndrome), topographically limited, treated by brachial plexus (BP) nerve roots or supra-scapular nerve (SSN) peripheral nerve stimulation (PNS). ⋯ In this pilot study, SSN or BP roots PNS provided a relatively safe, durable and effective option to control upper limb neuropathic pain.
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Observational Study
Effect of Multicolumn Lead Spinal Cord Stimulation on Low Back Pain in Failed Back Surgery Patients: A Three-Year Follow-Up.
Spinal cord stimulation (SCS) remains poorly efficient at reducing back pain in failed back surgery syndrome (FBSS) patients. We aimed at determining whether a new multicolumn lead SCS technique was efficient at durably reducing their leg (LP) and back (BP) pain. ⋯ Multicolumn lead SCS in FBSS patients significantly improve BP, LP, quality of life, and medication consumption for at least 36 months. A classical placebo effect cannot account for long-term improvements of such magnitude.
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While dorsal root ganglion (DRG) stimulation has been available in Europe and Australia for the past five years and in the United States for the past year, there are no published details concerning the optimal procedures for DRG lead implantation. ⋯ We present implantation techniques whereby a percutaneous lead is placed over the DRG through the use of a special designed delivery sheath. Further investigation of the safety, efficacy, and sustainability of clinical outcomes using these devices is warranted.