Neuromodulation : journal of the International Neuromodulation Society
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Many patients with intrathecal opioid pumps do adhere to the therapy for many years but there is scarce knowledge about the long-term effects of intrathecal opioid therapy (IOT) of more than three years. We sought to assess the long-term efficacy and the presence of typical side-effects and complications of IOT. ⋯ IOT seems to be effective also for long-term application. Clinically unwanted side-effects are relatively frequent but not the limiting factor for patient satisfaction.
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The efficacy of traditional spinal cord stimulation (t-SCS) tends to decay over time in patients with complex regional pain syndrome (CRPS). While it has been shown that dorsal root ganglion (DRG) stimulation is extremely effective in t-SCS-naïve patients with CRPS, its efficacy in patients who had previously failed t-SCS is unknown. Given that DRG-SCS and t-SCS target different spinal pathways, a failure with t-SCS should not automatically preclude a patient from attempting DRG-SCS. ⋯ Our case series demonstrates that a failure of t-SCS is not necessarily a failure of neurostimulation as a whole. The efficacy of DRG-SCS is independent of prior t-SCS therapy outcomes in these two patients and a history of t-SCS failure serves no predictive value in these two patients for future DRG stimulation success. Therefore, DRG-SCS can be considered as a reasonable next-step to salvage patients with CRPS who had failed other SCS treatments.
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To illustrate the obstacles and problems with electrical fields (EFs) in treatment and management of skin wounds. Unlike the literature that gives evidence for EF promoting wound healing, there is relatively little research to illustrate the interference of wound healing with EFs. ⋯ It is possible that EF can also negatively impact healing of a wound, and thus should be a consideration to clinicians when a delay in proper wound healing is encountered postoperatively. Therefore, in the postoperative period, when the wound healing is most active, we recommend avoiding programs that require frequent pulse generator recharges.
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One complication associated with the refill procedure of intrathecal drug delivery systems (IDDSs) include a "pocket fill," which is the inadvertent injection of the drug into the subcutaneous space surrounding the pump. The purpose of our study was to assess the mean volume discrepancy between the injected and the effective drug volume inside the IDDS reservoir after refills that did not lead to signs of overdose and to record at which volume discrepancy symptoms of overdose were noticed. ⋯ A volume discrepancy of >1 mL in 20 mL IDDSs and of >2 mL in 40 mL IDDSs after refill should be regarded as potentially consequential with regard to risk of overdose possibly caused by a pocket fill. In case of potentially consequential volume discrepancies, hospitalization and monitoring is recommended to preclude late overdose symptoms outside the hospital.