Surg Neurol
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Although the basic efficacy of dorsal column stimulation (DCS) has been shown, its optimal use remains to be defined. Since 1970, a program designed to maximize clinical success with DCS has been under way at Temple University Health Sciences Center. This article reviews patients screening, operative technique, new instrumentation and postoperative adjustment in DCS. Clinical results and long-term impressions of 90 implants in 75 patients are reported.
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A series of 120 patients with pain syndromes of varying sources were subjected to peripheral nerve electrical stimulation. Transcutaneous, percutaneous and depth electrode stimulation methods were employed. ⋯ The remaining 62 patients obtained no relief. Pain sources are correlated with treatment results.
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Twenty-three patients underwent implantation of a stimulator system and were followed for 6-20 months. Twenty patients estimated between 50% and 100% pain relief. ⋯ Reduced drug intake and improved social performance were associated with subjective improvement. The surgical technique is given, complications are analyzed and parameters are discussed.
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One of the pre-operative screening tests for dorsal column stimulation involves direct acute precutaneous stimulation of the dorsal column. The test simulates the postoperative therapeutic situation, shows the patient's reactions to electrically induced paresthesias and enables physician and patient to evaluate beforehand the degree of pain relief to be obtained with the implant.
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Twenty-seven patients with chronic pain had dorsal column stimulators implanted for pain control over a period of three years. Technical factors of electrode placement and type of unit were not found to correlate with the degree of pain relief. The preoperative psychological attitude of the patient correlated highly with the degree of pain relief and was the single most important factor in patient selection and evaluation. Theoretical concepts of pain psychophysiology in relation to the gate theory and areas for more extensive investigation of pain are discussed.