Neuromodulation : journal of the International Neuromodulation Society
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Two cases of chronic pelvic pain of unknown etiology with symptoms referable to the low abdominal wall are presented. These patients are often difficult to manage because of multiple causes and multiple pathways for pain transmission from the pelvis. ⋯ The patients reported excellent relief of their chronic pelvic pain. The use of neuromodulation via peripheral stimulation deserves further investigation as an alternative to spinal cord stimulation for chronic pelvic pain.
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Vagal nerve stimulation (VNS) has been approved for treatment of refractory depression (or treatment-resistant deperssion) and bipolar disorder in Europe and Canada since 2001 and in United States since 2004 by the Food and Drug Administration. Several lines of evidence support an effective antidepressant effect with such treatment modality, outcomes being mainly evaluated with Hamilton Rating Scale for Depression (HRSD). We here report a series of nine patients with severe treatment-resistant deperssion. ⋯ The preoperative psychiatric status and postoperative clinical outcome were both evaluated with the 21-item version of the HRSD (HRSD(21) ). Five out of nine patients, having at least one-year follow-up, were responders (≥50% reduction of HRSD scoring) and four of these also were remitters (HRSD < 10). One patient with bipolar II disorder and one patient with melancholic depression did not significantly benefit from the procedure; the latter three patients have follow-ups shorter than three months and one of them meets the remittance criteria; nonetheless, for the other two , HRSD(21) score is gradually decreasing with time.
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Objectives. This study is to evaluate long-term lead failure in spinal cord stimulation. Materials and Methods. One hundred and seven patients with permanently implanted spinal cord stimulators were studied for 14 years. All suspected paddle-lead failures were studied prospectively using preoperative radiography and intraoperative electric interrogation. ⋯ The mean time to primary lead failure was 37.9 months and to recurrent lead failure was 23.7 months. Conclusion. The incidence of primary lead failure remains low at 14.9% in the long run, but it is a significant adverse risk factor for recurrent paddle-lead failure. Great care should be undertaken to prevent lead failures by appropriate anchoring.
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Objective. This descriptive study compares outcome measures of a computerized assessment of pain, emotional distress, and quality of life between chronic noncancer pain patients who have received an implantable device (spinal cord stimulator or intrathecal pump; N = 143) and those who have not received a device (N = 130). Methods. Each patient marked the location of their pain on a body diagram and rated pain intensity, emotional distress, and impact of their pain on mood, sleep, and quality of life using a computerized pain assessment program. An electronic version of the Hospital Anxiety and Depression Scale (HADS) also was administered. ⋯ The patients with implantable devices also scored lower on the HADS Depression Subscale. Conclusion. The results suggest that although patients with an implantable device seem to have more pathology and greater disability, they report less emotional distress and improved quality of life compared with patients with chronic pain without an implantable device. Future controlled trials are needed to establish the role that an implantable device plays in improving mood and quality of life.
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Neuropathic facial pain often is a very difficult problem to treat. We describe three cases of intractable neuropathic facial pain which were successfully treated with peripheral stimulation. These three cases review trialing, operative considerations, including cosmetic considerations, and provide some insight into the pathophysiology of these pain syndromes.