Neuromodulation : journal of the International Neuromodulation Society
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The history of the use of electrical stimulation for pain is a cavalcade of research and innovation of many great scholars, scientists, and physicians over centuries that continues up to the present day. The legacy of this philosophy, research, and innovation is the field of neuromodulation for pain control. Today, patients with chronic pain from damage to the nervous system and chronic pain of the extremities, the axial low back, and neck, the face, and the viscera, all derive benefit from these early pioneers that have led to the expanding field of neuromodulation ... "on the shoulders of giants." We present here a history of the understandings of pain from the ancients to the present, which has led to our understandings of the use of electricity to cure disease and release patients from their suffering, generating the new, exciting, and expanding field of neuromodulation.
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Introduction. Spinal cord stimulation (SCS) is an effective treatment option for neuropathic pain. However, because of the obvious procedural issues, SCS is unable to reach certain areas, such as the face, thorax, coccyx, the cervico-dorsal and lumbar areas, and the sacral, abdominal, and inguinal regions. On the other hand, these areas are easily reached by subcutaneous field stimulation. ⋯ As a result of pain reduction, the patients' quality of life improved. There were no adverse events reported except for early electrode array displacement in two of our patients. Conclusion. When SCS is not appropriate for certain neuropathic pain syndromes, subcutaneous field stimulation may be used with some degree of efficacy.
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Objectives. This study aims to assess the efficacy of intrathecal infusion in different types of pain. A number of different variables were assessed to analyze their effect on therapy and to determine in which patients intrathecal infusion is more effective. Materials and Methods. A retrospective study was conducted with data obtained from 1983 to 2002. ⋯ The multivariate analysis (logistic regression analysis) revealed a significant difference with regard to gender, with an odds ratio of 2.78 in favor of male gender. When the efficacy and safety of the infusion was compared to the dose of morphine used, no significant differences were observed, with p = 0.65 for efficacy and p = 0.69 for safety. Conclusions. Pain relief was obtained with this technique in approximately 70% of patients, with no differences between pain types, but with a significant difference in favor of male gender.
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Objective. This study aims to investigate the movements of hyolaryngeal structures during the surface electrical stimulation of suprahyoid muscles and to compare these with movements during liquid swallowing. Materials and methods. Twelve volunteers without dysphagia participated in this study. Volunteers swallowed 5 mL of diluted barium liquid, which was recorded videofluoroscopically. ⋯ Trajectories of the hyoid and larynx during electrical stimulation were smaller than but similar to those that occurred during liquid swallowing. Conclusion. This study suggests that surface electrical stimulation of suprahyoid muscles causes the elevation and anterior excursion of hyolaryngeal structures, as is observed during normal physiologic swallowing, although the movements involved were smaller. Further studies are required to determine the effect of synchronized electrical stimulation on dysphagia patients with reduced laryngeal elevation to allow the development of a swallow-assisting neural orthosis.
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Objectives. The problem of treating patients in a vegetative state remains grossly unresolved, and spinal cord stimulation (SCS) had seemed promising in some studies, suggesting, to us, further study. Materials and Methods. A prospective uncontrolled and nonrandomized observational study for 20 consecutive years (1986-2005) was performed on the effect of SCS in 214 patients in persistent vegetative state (PVS) that resulted from global anoxia and/or, stroke and/or head injury. ⋯ Results. Excellent and positive results were obtained in 109 of 201 patients (54%), but better in those patients below the age of 35, those of PVS of traumatic origin and those patients with regional cerebral blood flow over 20 mL/100 g/min. Conclusions. These findings, though inconclusive of actual benefit of SCS for PVS, indicate to us that further evidence-based, randomized controlled trials are needed to confirm efficacy of the treatment and define those who are going to benefit from this treatment method.