Neuromodulation : journal of the International Neuromodulation Society
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Complications of intrathecal drug delivery are relatively rare. Of these, infections, cutaneous erosion, and granulomas account for the most common complications. The latter is often noticed when the patient shows signs of sedation and/or reduced pain relief. ⋯ Here, we present a case where a catheter-tip granuloma formed within 5 weeks of intrathecal morphine. The patient was carrying an intrathecal pump for 3 months when it was diagnosed. Probable causes of the formation are discussed.
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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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Currently accepted chronic pain treatment algorithms have positioned therapies according to levels of invasiveness and up-front costs. After reviewing updated literature on efficacy and cost outcomes of care for patients with chronic pain that include interventional implantable technologies, we offer a new model of thinking when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles. These SAFE principles include "safety,"appropriateness,"fiscal neutrality," and "efficacy."