Neuromodulation : journal of the International Neuromodulation Society
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Review Case Reports
Subcutaneous peripheral nerve stimulation with inter-lead stimulation for axial neck and low back pain: case series and review of the literature.
While pain in the extremities often responds to treatment using spinal cord stimulation (SCS), axial pain is notoriously refractory to SCS. Interest in subcutaneous peripheral nerve stimulation (SQ PNS) as an alternative to SCS has emerged, but the most appropriate electrode locations and neurostimulator programming techniques are not yet clear. ⋯ SQ PNS is a promising therapy for axial neck and back pain based on a small cohort of patients. Ultrasound was useful to assist with electrode placement at the most appropriate depth beneath the skin. While inter-lead stimulation has been preferred by patients in published reports, we did not find it clearly influenced pain relief. Future investigations should include a randomized, controlled study design, as well as defined implantation technique and neurostimulator programming algorithms.
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Complex regional pain syndrome type 1 (CRPS-1) has a 31% probability of becoming chronic. The early use of spinal cord stimulation (SCS) has been recommended as a strategy to prevent chronicity and functional impairment. ⋯ We conclude that the feasibility of performing a randomized controlled trial on early SCS therapy in CRPS-1 is low because of the good disease improvement with standard therapy in the first year after onset. This study raises questions about the need to use SCS early in the course of CRPS-1 because of the probable lack of additional benefit compared with SCS in chronic CRPS-1.
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Randomized Controlled Trial Comparative Study
A comparison of the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) and non-invasive interactive neurostimulation (InterX(®)) on experimentally induced blunt pressure pain using healthy human volunteers.
Non-invasive interactive neurostimulation (InterX(®)) delivers high amplitude electrical pulsed currents at points of low impedance on the skin. This study compared the hypoalgesic effect of non-invasive interactive neurostimulation with transcutaneous electrical nerve stimulation (TENS). ⋯ Given the limited power of this study, we show that there were no significant differences in hypoalgesia between non-invasive interactive neurostimulation and TENS. Unlike our previous studies we also failed to detect a change pain threshold during TENS. Nevertheless, our findings can be used to inform the design of an appropriately powered study on pain patients.