Neuromodulation : journal of the International Neuromodulation Society
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Objectives Intraspinal drug delivery via indwelling pump is an effective means of treating refractory pain. Before a patient is selected for pump implantation, an intraspinal drug delivery trial must be performed to establish side-effects and efficacy profiles. No consensus protocol currently exists for such trials. ⋯ Nearly half (45%) of the respondents use the continuous intrathecal infusion technique to select patients for permanent implants. Conclusions Trial practices vary widely in terms of patient selection, medication choice, technique, and efficacy evaluation. We hope that our findings will encourage a concerted effort to evaluate existing trial protocols in order to establish a reliable standard of care.
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Objectives The objective of this paper is to report the clinical protocols that we have developed and used for titrating constant flow implantable pumps to an effective dose in de novo pain and spasticity pump patients and, thereby, highlight the similarities and differences in our techniques. As a group, we have implanted over 1600 pumps and currently manage over 800 pump patients. ⋯ This compares favorably to reports of programmable pumps requiring 5.3 ± 3.5 adjustments over a period of 3-6 months to reach an effective dose. Conclusions A comparison of our protocols shows that after an initial stabilization period, dose adjustments can be made at subsequent refill, that it is not necessary to adjust the dose by prematurely emptying and filling constant flow pumps, and that it is not necessary to adjust the dose as often as has been done with programmable pumps.
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Objective Low intensity and low frequency electromagnetic field stimulation (EMFs) provides substantial pain relief in patients with various chronic pains. The aim of this study was to examine the effects of EMFs on the activity of thoracic spinal neurons responding to noxious visceral stimuli. Materials and Methods Extracellular potentials of single T(3) -T(4) spinal neurons were recorded in pentobarbital anesthetized male rats. ⋯ Even after termination of EMFs, the suppression of spinal neuronal activity lasted for 1-2 hr. In contrast, excitatory responses of 7/18 (39%) neurons to esophageal distension were inhibited, five (28%) were excited and six (33%) were not affected by EMFs. Conclusions Results showed that EMFs generally reduced nociceptive responses of spinal neurons to noxious cardiac chemical stimuli, whereas it was not effective for nociceptive responses to esophageal mechanical stimulation.
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The present experiments were performed on rat colon to study neurogenic and myogenic elicited propulsion induced by 0.3 and 30 msec long current pulses. The colon segments were stimulated sequentially and randomly. The obtained contractions displaced the intraluminal content in individual propulsion steps. ⋯ When inhibiting cholinergic transmission by atropine, the propulsion induced by 0.3 msec pulses was blocked, while partially inhibited when using 30 msec pulses. Inhibiting nitric oxide synthesis by N(G) -nitro-L-arginine methyl ester (L-NAME) blocked propulsion induced by both of the pulse durations. In conclusion, electrical stimulation induces propulsion when using both 0.3 and 30 msec long pulses; stimulation using 0.3 msec pulses activates neurons, whereas 30 msec pulses depolarize muscles; in the absence of nitrergic transmission, propulsion cannot be induced by electrical stimulation.