Neuromodulation : journal of the International Neuromodulation Society
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Intraoperative neuromonitoring (IONM) through electromyography (EMG) studies has been shown to be a safe, effective way to determine the laterality of the spinal cord and guide electrode placement during spinal cord stimulation (SCS). However, the use of IONM to predict post-operative energy requirements and midline has not been examined and offers a new avenue to streamline programming and device selection. Further, the impact of cerebrospinal fluid (CSF) thickness on intraoperative and post-operative amplitudes is understood but has not been explicitly characterized. ⋯ EMG accurately predicts post-operative energy requirements and midline in SCS patients. While 29.17% of patients did not have a match between their intraoperative and post-operative midlines, EMG testing was still valuable in guiding electrode placement and providing information to predict post-operative intensities. Additionally, CSF thickness correlated with amplitude settings on the first post-operative day.
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Spinal cord stimulation (SCS) is a recognized management option for patients with refractory neuropathic pain. Despite randomized controlled trials reporting the effectiveness of SCS, there is a lack of long-term data reflecting usual SCS practice. The aim of this study is to present the long-term outcomes of a cohort of patients from a single centre undertaking SCS with devices from a single manufacturer. ⋯ Patients with neuropathic pain undertaking SCS experience long-term reductions in pain intensity and increases in health utility and associated QALY gains. The findings from this study associated with the increased longevity of rechargeable SCS devices suggest that the cost-effectiveness of SCS may become increasingly favourable when compared with conventional medical management.
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The case report details to use of three-dimensional (3D) printing as an aid to neuromodulation. ⋯ Neuromodulation techniques can provide the optimal analgesic techniques for individual patients. At times these can fail due to lack of access to the site for intervention, in this case epidural access. 3D printing may provide additional information to improve the likelihood of access when anatomy is distorted and standard approaches prove difficult.
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Comparative Study
Transcutaneous Recharge: A Comparison of Numerical Simulation to In Vivo Experiments.
Numerical simulation and animal experiments quantified tissue temperatures during the transcutaneous recharge of neuromodulation implants. The temperature results were used to determine the likelihood of tissue injury in humans. ⋯ The numerical simulation predicts tissue temperatures during transcutaneous recharge of implants. Results show that the implant depth does not have a large impact on the tissue temperatures and thermal exposures are sufficiently low so that they are unlikely to have any physiologic consequence.
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Neuropathic pain is difficult to manage and treat. Spinal cord stimulation (SCS) has become an established procedure for treating chronic neuropathic pain that is refractory to pharmacological therapy. In order to achieve better analgesia, a number of studies have evaluated the effectiveness of combining drug therapy with SCS. Cholecystokinin antagonists, such as proglumide, enhance the analgesic efficacy of endogenous opioids in animal models of pain. We previously reported that both systemic and spinal administration of proglumide enhances analgesia produced by both low- and high-frequency transcutaneous electrical nerve stimulation (TENS). Since SCS produces analgesia through endogenous opioids, we hypothesized that the analgesic effect of SCS would be enhanced through co-administration with proglumide in animals with neuropathic pain. ⋯ Proglumide may be a candidate for achieving analgesia for patients with refractory neuropathic pain conditions, but does not enhance analgesia produced by SCS.