Neuromodulation : journal of the International Neuromodulation Society
-
Objective. The aim of this study was to investigate the effects of spinal cord stimulation (SCS) on peripheral circulation in rats with streptozotocin (STZ)-induced diabetes. Materials and Methods. Four weeks after streptozotocin or vehicle was injected (i.p.) in male Sprague-Dawley rats, SCS-induced vasodilation was examined. Results. Plasma glucose concentration was significantly higher in diabetic rats than in the control animals. ⋯ SCS-induced vasodilation was attenuated at 90% of the MT, but not at 30% and 60% of MT in diabetic rats when compared to control rats (p < 0.001, N = 13). Furthermore, increasing SCS from 30% to 90% of MT typically produced a progressive increase in blood flow in control rats but not in diabetic rats (p < 0.01, N = 13). Conclusion. This study suggested that SCS-induced vasodilation improves peripheral blood flow, although the pathways were partially impaired in the diabetic condition.
-
Objective. Spinal cord stimulator (SCS) parameter settings have been well studied; however, the goal of this exploratory study was to examine the SCS parameters used during intra-operative stimulation (IOS) at trial lead placement. Methods. In this retrospective study, we report the IOS parameter settings for 22 patients who underwent thoracic SCS lead trial for treatment of refractory low back and/or leg pain. Results. Paresthesia coverage was shown to differ depending upon the pain syndrome and the region involved (back and/or leg, p = 0.03). ⋯ Important variations in field configuration practice patterns also emerged. Conclusions. Larger prospective studies are required to confirm and extend the current results. The ultimate goal for this report is to establish a foundation for future studies to create an evidence-based standardized algorithm for IOS to enhance the success rate of SCS trial screening.
-
Introduction. Intractable pain in the affected arm is a common sequel to severe traction lesions of the brachial plexus. Its management presents a challenge. Existing interventional therapies are not effective for the intractable pain from brachial plexus traction lesions, in the long term. ⋯ Methods. We report here a single case report of the successful management of intractable pain of uncertain pathology following traction injury of the shoulder and brachial plexus with the percutaneous implantation of a permanent stimulating electrode via a stimulating needle to the brachial plexus using the posterior route at the interscalene level. Results. Stimulation of the brachial plexus in this one patient has resulted in excellent pain control and unexpected beneficial sensory and motor changes in the arm of the patient. Conclusions. We cautiously conclude that percutaneous implantation of a stimulating electrode to the brachial plexus via a stimulating needle is a relatively simple procedure when compared to surgical implantation and, as shown in our case, very effective.
-
We present here a technique to mitigate the complication of multiple needle entries into the thecal sac when attempting to place an intrathecal catheter into the thecal sac. Our technique of injecting radio-opaque contrast material after entering the epidural space and before entering the thecal sac allows for visualization of the thecal sac within the spinal canal, thus obviating the technique of "fell and pop" to enter the sac. In our hands, this technique has improved outcomes for our patients and has decreased the incidence of post dural puncture headache, neural trauma and technical failures.
-
Electrical stimulation of the digestive organs may become a valuable alternative to pharmaceutical and surgical approaches to the treatment of gastrointestinal motor dysfunctions. For more than 40 years, encouraging results with electrical stimulation to activate motility in gastrointestinal organs have been published. ⋯ In addition, animal studies have investigated the different stimulation systems and methods to activate or inhibit transit in the small and large intestines. This article presents a review of the published literature on electrical stimulation of the stomach and intestines.