Neuromodulation : journal of the International Neuromodulation Society
-
Introduction. Chronic pain is a prevalent medical condition in the general population and is one of the most common reasons patients visit their primary care doctors. When the pain is resistant to the common treatment modalities, it presents a challenge for the physician and may have profound consequences for the quality of life of the patient. ⋯ The patients reported decreased use of pain medications, increased quality of life, and high satisfaction with the procedure results. Conclusion. The use of subcutaneous peripheral nerve stimulation as a viable treatment alternative in certain cases of chronic neuropathic pain should continue to be rigorously evaluated.
-
Objectives. This technical report provides a detailed description of a method of transforaminal nerve root stimulation useful in the treatment of chronic pain conditions. Material and Methods. We describe a patient who presented with a medically refractory peripheral neuropathy and suffered from bilateral foot pain. We utilized transforaminal nerve root stimulation to provide robust stimulation paresthesias to the painful areas. ⋯ Results. The patient experienced appropriate pain relief after the stimulation and did not have any complications related to the procedure. Conclusions. We describe a method of transforaminal nerve root stimulation that can be easily implemented by providers using the standard tools available to them. Transforaminal nerve root stimulation may be appropriate for patients in whom more traditional approaches such as spinal cord stimulation or peripheral nerve stimulation are suboptimal.
-
Objectives. To investigate the different approaches in the field of functional electrical stimulation (FES) control of gait and address fundamental perquisites to enable FES walking systems to become safer, more practical, and therefore clinically efficacious. Design. Systematic review was conducted from electronic data bases up to March 2008. Studies with innovative control strategies were highlighted for analysis, but all relevant literatures were described to deliver a broad viewpoint. ⋯ Finite state controllers based on a set of deterministic rules to process feedback signals seemed more suitable to provide accurate command-and-control compared with dynamic or neural network controllers. Conclusions. Progress in the development of closed-loop FES walking systems has been impeded by their lack of practicality. In the near future, this obstacle could be overcome via implanted systems, especially if using controllers based on deterministic rule sets derived from motion sensor feedback.
-
Objective. Percutaneous techniques for occipital nerve stimulation have been in the literature since 1999. Lead migration continues to be the most common complication to the technique. The authors would like to introduce a new technique for revision of a superficially migrated occipital nerve stimulator electrode. ⋯ He had no signs of infection and full return of prior function of the stimulator at two weeks and three-month follow-up visits. Conclusion. This case demonstrates a new safer technique for revision of a superficially migrated occipital nerve stimulator lead. The technique is a more direct and simple solution to a common problem in the percutaneous placement of occipital nerve stimulators.
-
Objectives. Post-herpetic neuralgia (PHN) is a painful complication of herpes zoster infection and a common cause of chronic severe pain in elderly and/or debilitated patients. Although a wide range of treatments have been tried, a substantial number of patients continue to experience pain which remains refractory to all therapies. Increasingly, studies have demonstrated that oral opioids can have a beneficial effect on neuropathic pain. ⋯ Patients most commonly reported improvement in the deep component of their pain, next allodynia, and less so superficial lancinating pain. Conclusions. In conclusion, while a complex therapy, long-term use of intrathecal opioids is well tolerated, doses are titratable, administration is safe, and may help relieve severe short- and long-term neuropathic pain in selected PHN patients. Whether the addition of newer investigational intrathecal agents could improve these results is yet to be determined.