Neuromodulation : journal of the International Neuromodulation Society
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Objectives To retrospectively analyze by indices of success, patients with chronic complex pain, including, axial low back pain, receiving dual spinal cord stimulation (SCS) systems. Methods Eighteen patients with dual spinal cord stimulators have been retrospectively and nonrandomly analyzed. The preponderance of patients in our study group had failed back surgery syndrome (FBSS). ⋯ Thirteen (81%) patients with dual lead SCS therapy were willing to repeat the SCS implant procedure. Complications occurred in 43.7%. Conclusions Dual spinal cord stimulation is appropriate and efficacious for treating complex pathology and complex pain that including pain of the low, axial back.
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Sjögren syndrome is a chronic autoimmune disease. This disease mainly involves salivary and lacrimal glands, although it may also involve the musculoskeletal, respiratory, gastrointestinal, renal, hepato-biliary, hematological, neurological, vascular, or both systems. Small vessel disease may appear in up to 30% of the cases. ⋯ In our pain unit, a percutaneous posterior spinal cord stimulator (SCS) was placed. SCS clinically reduced her pain by 90% and helped to improve her quality of life and significantly reduced her intake of analgesics. We conclude spinal cord stimulation may be a good alternative to conservative therapies in patients with vasculitis of Sjögren syndrome.
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Objective To compare the technical performance of different percutaneous lead types for spinal cord stimulation. Methods Using the ut-scs software (University of Twente's spinal cord stimulation), lead models having similar characteristics such as the 3487A PISCES-Quad (PQ), 3887 PISCES-Quad Compact (PC), 3888 PISCES-Quad Plus (PP) (Medtronic Inc., Minneapolis, MN), and the AB SC2108 (AB) (Advanced Bionics Corp., Valencia, CA) were simulated in monopolar and tripolar (guarded cathode) combinations on a single lead, placed just outside the dorsal dura mater and both centered on the spinal cord midline, and at 1 mm lateral. The influence of displacing a lead dorsally in the epidural fat was examined as well. ⋯ Conclusions Complex pain syndromes are treated best with lead having a small contact spacing, being programmed as a tripole (guarded cathode) and centered on the spinal cord midline just outside the dura mater. This is because dorsal column fiber recruitment is more extensive than with any other combinations, including dual leads. Improved recruitment of dorsal column fibers is accompanied by increased energy consumption.
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The objective of this study was to evaluate the long-term infection risk from refilling intrathecal drug delivery devices. We studied 25 patients (14 females and 11 males) with intrathecal infusion pumps placed for spasticity (23 patients) and chronic pain (two patients). In this study group there were 890 refill procedures (mean 35.6 ± 20.5; range 8-72 times) performed on an outpatient basis by four different physicians. ⋯ All cultures, in all pumps, were negative for aerobic and anaerobic bacteria. We conclude that periodic refills of intrathecal implanted pumps do not seem to be a risk factor for infection if standard sterile refill procedures are performed. In this study, it was clear that comorbid infections from other parts of the body do not present as a risk for device contamination.
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The objective of this study was to objectively assess the physical activity of daily living in chronic pain patients treated with spinal cord stimulation (SCS). Changes in pain and spontaneous physical activity following SCS were evaluated under real life conditions. Five series of measurements were performed before the implant (baseline) and at one, three, six, and 12 months after the implantation of an SCS system. ⋯ The average total walking distance increased up to 389% at 12 months, reaching statistical significance (p < 0.05) after three months. The stride length and the speed increased (p < 0.01) at all times. We conclude that the reduction in pain intensity due to SCS is associated with a progressive and sustained improvement in physical activity. j.