Neuromodulation : journal of the International Neuromodulation Society
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Objective. Development of a spinal cord stimulation (SCS) system in a mouse model of chronic neuropathic pain. Materials and Methods. Male C57BL/6 mice (N = 6) underwent a partial ligation of the sciatic nerve. Development of mechanical hyperalgesia was tested using the withdrawal response to tactile stimuli with the von Frey test. ⋯ After termination of the SCS, the withdrawal threshold of the ipsilateral paw slowly decreased. No effect of SCS on the contralateral paw was noted. Conclusion. The development of a mouse SCS system is described that is practical in use, is reproducible, and shows a comparative therapeutic effect in treatment of chronic neuropathic pain as reported in rat.
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Objectives. To assess the mode-of-use of implanted programmable infusion pumps in patients with nonmalignant, chronic low-back pain. Materials and Methods. Charts from 101 consecutive eligible patients were analyzed retrospectively. Data were extracted relating to patient demographics, pump mode of infusion and flow rate, and medications used. ⋯ For patients attaining constant-flow treatment, mean time from implantation to start of such treatment was 2.7 months. Discussion. The results suggest that many patients with nonmalignant low-back pain could be implanted with a constant-flow pump when their programmable device needs replacing or, in some cases, at the start of intrathecal treatment. This would reduce costs and the requirement for surgery.
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Background. Initially developed to excite peripheral nerves, magnetic stimulation was quickly recognized as a valuable tool to noninvasively activate the cerebral cortex. The subsequent discovery that repetitive transcranial magnetic stimulation (rTMS) could have long-lasting effects on cortical excitability spawned a broad interest in the use of this technique as a new therapeutic method in a variety of neuropsychiatric disorders. Although the current outcomes from initial trials include some conflicting results, initial evidence supports that rTMS might have a therapeutic value in different neurologic conditions. ⋯ Lastly, only two randomized, sham-controlled studies have been performed for epilepsy; although evidence indicates rTMS may reduce seizure frequency in patients with neocortical foci, more research is needed to confirm these initial findings. Conclusions. There is mounting evidence for the efficacy of rTMS in the short-term treatment of certain neurologic conditions. More long-term research is needed in order to properly evaluate the effects of this method in a clinical setting.
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Background. Patients with unstable angina pectoris may become refractory to conventional therapies. Electrical neurostimulation with transcutaneous electrical stimulation and/or spinal cord stimulation has been shown to be effective for patients with refractory unstable angina pectoris in hospital settings. Our aim was to investigate the effects of electrical neurostimulation on outcomes of unstable angina after hospital discharge, in terms of hospital re-admission rates and long-term survival analysis. ⋯ The combined mortality and (re)infarction rate after one-year follow-up was 14%. Conclusion. The results of this observational study show long-term beneficial effects of electrical neurostimulation in a population of patients with unstable refractory angina. Therefore, electrical neurostimulation should be considered as a beneficial treatment for patients with unstable angina pectoris, refractory to conventional therapies.
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Background. Expert panels of physicians and nonphysicians in the field of intrathecal therapies convened in 2000 and 2003 to make recommendations for the rational use of intrathecal analgesics based on the preclinical and clinical literature known up to those times. An expert panel of physicians convened in 2007 to update previous recommendations and to form guidelines for the rational use of intrathecal opioid and nonopioid agents. ⋯ Results. The panelists, after review of the literature from 2000 to 2006 and discussion, created an updated algorithm for the rational use of intrathecal opioid and nonopioid agents in patients with nonmalignant and end-of-life pain. Of note is that the panelists felt that ziconotide, based on new and relevant literature and experience, should be updated to a line one intrathecal drug.