Pain physician
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Randomized Controlled Trial Multicenter Study
Sensor-driven position-adaptive spinal cord stimulation for chronic pain.
Variation in the intensity of neurostimulation due to body position is a practical problem for many patients implanted with spinal cord stimulation (SCS) systems because positional changes may result in overstimulation or understimulation that leads to frequent need for compensatory manual programming adjustments. ⋯ NCT01106404.
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Randomized Controlled Trial
Lumbar interlaminar epidural injections in central spinal stenosis: preliminary results of a randomized, double-blind, active control trial.
Chronic, persistent low back and lower extremity pain is often caused by spinal stenosis. Surgery and other interventions, including epidural injections, have been used to relieve this pain. However, there is little in the medical literature to support interlaminar, or transforaminal epidural injections under fluoroscopy for managing lumbar pain of central spinal stenosis, while the caudal epidural approach has been studied. ⋯ NCT00681447.
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Intrathecal delivery of baclofen (ITB) is effective at controlling spasticity. However, it requires the placement of a catheter into the intrathecal space, and a pump with a reservoir for the medication. The process of placing the catheter and pump are prone to complications. ⋯ Complication rates after placement of intrathecal pump/catheters have increased in the pediatric population between 1997 and 2006 mainly due to an increase in mechanical complications.
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In 2000 the intradiscal electrothermal therapy (IDET) procedure for the treatment of discogenic pain was introduced. The technique involves the positioning of an intradiscal catheter with a temperature-controlled thermal resistive heating coil at the inner posterior annulus. The therapeutic mechanism of IDET combines the thermo-coagulation of native nociceptors and in-grown nonmyelinated nerve fibers with collagen shrinkage, stabilizing annular fissures. Thermal nerve root injuries were described with IDET. The temperature in relation to the distance from the catheter tip was investigated. The intradiscal temperature distribution during treatment with IDET was also described. ⋯ This study shows that temperatures generated within the spinal canal during IDET do not appear to be high enough to cause nerve damage.