Neuromodulation : journal of the International Neuromodulation Society
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Introduction. Loin pain-hematuria syndrome (LPHS) is a rare clinical entity causing unilateral or bilateral intractable flank and loin pain with hematuria. The etiology is poorly understood, and the diagnosis is made by exclusion of urological and nephrological conditions. The management is mainly symptomatic aiming for pain relief with nonopioid and opioids analgesics, and interventions such as capsaicin infusion into the renal pelvis, percutaneous regional nerve blocks, and laparoscopic or open surgical procedures, none of them providing lasting pain relief. ⋯ All our patients preferred low-frequency stimulation although its precise mode of action is uncertain. Conclusion. Our experience shows that lumbar sympathetic chain neuromodulation in intractable LPHS not amenable to conservative therapy is a reasonable alternative before radical interventions. More experience is needed in multiple centers before its recommendation for refractory LPHS.
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Introduction. Peripheral nerve stimulation (PNS) has been used for many years to treat neuropathic pain syndromes. Technical advances in neurostimulation hardware have led to a renewed interest in the use of PNS for control of intractable pain caused by peripheral mononeuropathies. One such application includes intractable groin pain. ⋯ Discussion. The successful use of ultrasound as described in these two cases suggests an important role for ultrasound in localization of targeted nerves in percutaneous trial stimulation of injured peripheral nerve. The use of ultrasound may also play a role in permanent lead placement as well. Conclusion. More studies are needed to further qualify the role of ultrasound in isolating peripheral nerves, but the success of trial stimulation in these two cases holds promise for continued advancements in the field of neuromodulation.
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Introduction. Spinal cord stimulation (SCS) is an accepted cost-effective therapy for many chronic pain syndromes. Its effects on pregnancy have not been studied because of stringent regulation and manufacturers' recommendations. However, childbearing women who had SCS become or choose to become pregnant despite these policies. ⋯ Therefore our case highlights the need to implant the IPG in a way that avoids stretching the lead extender by the expanding abdomen. Conclusion. SCS seems to be safe in the first two trimesters of pregnancy based on these two case reports and the abdominal wall should be avoided as a site for IPG implantation in these patients. However, more cases are required to establish the safety of SCS in pregnancy.
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Objective. To present a novel technique of neuromodulation for the treatment of axial neck pain. Materials and Methods. A case of a patient with history of long-standing axial neck pain with previous cervical spine operation and confirmed discogenic pain is presented. Traditional treatment measures did not provide adequate pain relief. ⋯ The patient was gradually weaned off of all opioid medications and continues to report 100% reduction in pain intensity at the nine-month follow-up. Conclusion. PSFS represents a new and promising modality in treatment of axial neck pain. Exact mechanism of the pain relief remains unclear.
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Objective. To report a case of improved urodynamics in a central cord syndrome spinal cord injury after intrathecal baclofen therapy. Methods. A 47-year-old man fell resulting in C4-C5 disc herniation with ventral spinal cord compression and cord edema. Results. He underwent an anterior cervical discectomy and fusion. ⋯ After intrathecal pump therapy, CMG revealed relatively normal detrusor and minimal sphincter tone. He volitionally voids with urgency but improved continence, which was maintained in one-year follow-up. Conclusion. Although the main indication for intrathecal baclofen therapy is spasticity, improved urodynamics can be an additional benefit in central cord syndrome spinal cord injury.