Neuromodulation : journal of the International Neuromodulation Society
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Comparative Study
Comparison of a novel fixation device with standard suturing methods for spinal cord stimulators.
Spinal cord stimulation is a well-established treatment for chronic neuropathic pain of the trunk or limbs. Currently, the standard method of fixation is to affix the leads of the neuromodulation device to soft tissue, fascia or ligament, through the use of manually tying general suture. A novel semiautomated device is proposed that may be advantageous to the current standard. Comparison testing in an excised caprine spine and simulated bench top model was performed. ⋯ These data suggest a novel semiautomated device offers a method of fixation that may be utilized in lieu of standard suturing methods as a means of securing neuromodulation devices. Data suggest the novel semiautomated device in fact may provide a more secure fixation than standard suturing methods.
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Eddy currents in the metal shell and copper losses in the coils generate heat in rechargeable neurostimulators, which increases the temperature of the adjacent tissue, potentially causing thermal damage of implant patients. Hence, there is an urgent need for a simple self-help method to measure the temperature of such subcutaneous devices. ⋯ A convenient method was then given to monitor the adjacent skin temperature to evaluate the thermal hazards with a skin temperature threshold of 41°C. The proposed approach can be easily implemented by an implant patient at home to reduce the thermal risk, ease patient anxiety, and improve clinical outcomes.
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The aim of the study was to investigate the predictive value of percutaneous electrical nerve stimulation (PENS) in peripheral nerve stimulation (PNS) for chronic neuropathic pain. ⋯ Predicting response to PNS is crucial to reduce the number of patients implanted in vain. To adopt PENS via electroacupuncture needles as a percutaneous simulation method for PNS seemed to be feasible. The technique presented herein bears the potential to improve patient selection combined with reduced invasiveness. The presented results are encouraging and deliver a starting point for further trials.
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We hypothesize that intrathecal (IT) granulomas arising from the IT infusion of several opiates may result from the degranulation of meningeal mast cells (MC). Given functional covariance between cutaneous and meningeal MC, we propose that opioids that do not degranulate cutaneous MC will not produce a granuloma. An opioid meeting this criteria is the phenylpiperadine alfentanil HCl. ⋯ These results support the hypothesis linking MC degranulation and IT granulomas.