Pain physician
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Intermittent claudication is a typical symptom of lumbar spinal stenosis (LSS) and peripheral arterial obstructive disease (PAD). Because both LSS and PAD are predominantly associated with degenerative conditions, concomitant conditions are not uncommon. However, few reports of the demographic, clinical, and radiological characteristics of concomitant LSS and PAD (LSSPAD) have been published. ⋯ We found that concomitant PAD in patients with LSS is associated with old age, DM, the presence of aortic calcification, and ABI < 0.9. When these risk factors exist, further work up is needed to exclude the concomitant PAD.
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Case Reports
False positive radiographical evidence of pump catheter migration into the spinal cord.
Intrathecal drug delivery systems are becoming an increasingly common modality used by physicians to treat patients. Specifically, chronic spasticity secondary to multiple sclerosis (MS) may be treated with intrathecal baclofen (ITB) therapy when oral antispasmodics do not provide adequate relief. ITB therapy is effective, localizes drug delivery, and does not have the same degree of intolerable systemic effects often seen with oral and parenteral medications. ⋯ We present a case of an intrathecal baclofen pump catheter that was initially believed to have migrated into the spinal cord and the innovative use of cinefluoroscopy and digital subtraction used to identify catheter placement. Moreover, after confirmation of the catheter position within the spinal cord on magnetic resonance imaging (MRI) our team elected to perform a laminectomy, which demonstrated that the catheter was not in the spinal cord but was surrounded by arachnoid adhesions. We hope our efforts will provide the clinician insight into the common difficulties that arise and how best to troubleshoot them to serve this specific patient population and prevent potentially life-threatening complications.
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Percutaneous adhesiolysis (PA) is considered to be a reasonable nonoperative treatment for herniation of intervertebral disc (HIVD), spinal stenosis, and post-lumbar-surgery syndrome (PLSS). The success of PA depends on the removal of epidural fibrosis and drug delivery to the target region. However, prognostic predictors of the effects of PA are not well known. ⋯ Good prognostic predictors were identified as no previous lumbar surgery or root compression with HIVD or foraminal stenosis. These results are expected to contribute to the establishment of indications for PA.
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Comparative Study
Evaluation of interaction between a spinal cord stimulator and implanted cardioverter-defibrillator in a swine model.
Spinal cord stimulators (SCS) have been used for many years to treat a myriad of chronic pain conditions using electrical signals to diminish the perception of a painful stimulus. Because of the electrical nature of the devices, there is a concern about the potential for electromagnetic interaction between the device and lifesaving cardiac implantable cardioverters-defibrillators (ICVD). ⋯ This study clearly demonstrated the feasibility of the 2 devices coexisting and functioning appropriately in an animal model using an ICVD and SCS donated by Boston Scientific. Further studies are needed to elucidate restrictions, optimal settings and parameters in a human setting.
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Neuropathic pain induction by nerve injury has been shown by in vitro studies to be accompanied by synaptic strengthening in the anterior cingulate cortex (ACC) and has been shown by pharmacological studies in vivo to be prevented by blocking N-methyl-D-aspartate (NMDA) receptor-dependent ACC plasticity. These findings indicate that ACC neurons undergo nerve injury-induced synaptic modifications and further raise a new question about neuropathic pain-associated changes in neuronal activity in the ACC in vivo, particularly spontaneous neuronal oscillations - a process believed to be fundamental for many forms of brain function. ⋯ Neuropathic pain is accompanied by the increase in rates of spontaneous oscillations of ACC neurons. This change may be critical for neuropathic pain development, as well as pain hypersensitivity and spontaneous pain in neuropathic pain animals.