Pain management
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SUMMARY Pain is a complex behavior process, the anatomy and physiology of which is not completely understood, and is subject to continuous exploration and research. Following on the heels of Melzack and Wall's gate control theory of pain (1965), Shealey et al., in 1967, were the first to implant stimulation electrodes over the dorsal columns in an attempt to provide relief for patients with chronic, intractable pain. ⋯ In contrast to conventional medical management, SCS offers long-lasting symptom relief, improved quality of life and functional capability, often achieving these goals at a reduced cost. This article illustrates the present status, challenges and future of SCS.
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SUMMARY ⋯ In routine Slovenian clinical practice, transdermal buprenorphine provided efficient analgesia and was well-tolerated in patients with chronic moderate-to-severe cancer pain or chronic severe noncancer pain insufficiently controlled by nonopioids and, as the study results indicate, also in chronic severe noncancer pain insufficiently controlled by weak opioids.
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SUMMARY The increase in failed back surgery syndrome (FBSS) cases in the USA has been paralleled by an increase in the number of spinal cord stimulation (SCS) treatments performed. Over the last 40 years, SCS technique has improved drastically and has been shown to be efficacious in FBSS patients with radiculopathy and neuropathic pain. This article will focus on the current patient selection process of SCS in the setting of FBSS, with a review of pertinent clinical trials and current evidence-based guidelines. The current working mechanism of SCS, complications surrounding SCS and the definition of FBSS will also be briefly discussed.
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Stephen G Waxman speaks to Roshaine Gunawardana, Commissioning Editor: Stephen G Waxman is the Bridget Marie Flaherty Professor of Neurology, Neurobiology and Pharmacology; Director, Center for Neuroscience and Regeneration/Neurorehabilitation Research, Yale University School of Medicine and Veterans Affairs Medical Center, CT, USA.