Neuromodulation : journal of the International Neuromodulation Society
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Peripheral nerve field stimulation (PNFS) is a potential treatment for chronic low-back pain. Pain relief using PNFS is dependent on activation of non-nociceptive Aβ-fibers. However, PNFS may also activate muscles, causing twitches and discomfort. In this study, we developed a mathematical model, to investigate the activation of sensory and motor nerves, as well as direct muscle fiber activation. ⋯ The results suggest that direct muscle activation does not occur during PNFS, and concomitant motor and sensory nerve fiber activation are only likely to occur when using between-lead configuration. Thus, it may be relevant to investigate the location of the innervation zone of the low-back muscles prior to electrode implantation to avoid muscle activation.
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Selective-afferent vagal nerve stimulation (sVNS) may be a treatment option for therapy-resistant hypertension, as it lowers blood pressure (BP) in rats without causing significant side effects. Alpha-2-agonists are widely used for the treatment of withdrawal, chronic pain and other disorders, and even if sVNS becomes a treatment option for therapy resistant hypertension, in some patients it might be necessary to combine sVNS with an alpha-2-agonist like clonidine. Alpha-2-agonists exhibit a central and peripheral mechanism of action. This study investigated the influence of the commonly used alpha-2-agonist clonidine on sVNS. ⋯ The effect of sVNS on BP is dampened by clonidine, but sVNS can still lower the BP in clonidine treated rats without causing significant bradycardia.
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Ziconotide is a non-opioid analgesic for intrathecal (IT) administration. The aim of this review is to provide a comprehensive and clinically relevant summary of the literature on dosing and administration with IT ziconotide in the management of refractory chronic pain, and to describe novel dosing strategies intended to improve clinical outcomes. ⋯ Clinical trials and experience confirm the feasibility and usefulness of IT ziconotide in the management of refractory chronic pain. Emerging evidence suggests that additional IT delivery options may further expand the usefulness and benefits of ziconotide.