Articles: back-pain.
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Background. The treatment of chronic low back and leg pain remains a difficult medical challenge, particularly for patients with postlaminectomy syndrome. While spinal cord stimulation (SCS) has been a significant addition to the available options, it is often inadequate in relieving both the back and leg pain components. We hypothesized that for some patients the combination of SCS with peripheral nerve field stimulation (PNFS) would be a safe, effective alternative that would be more effective than either modality alone. ⋯ Conclusions. Due to the availability of 16 contact capacity generators, neurostimulation with multiple leads in various combinations-including both epidural and peripheral nerve field stimulation simultaneously-can be applied safely and effectively. The availability of this combined approach for a trial of stimulation prior to implant allows patients to compare SCS to PNFS and to indicate a preference for one over the other or for the combination. We conclude that PNFS may be used in combination with SCS as a safe and effective alternative treatment for patients with chronic low back and leg pain, and further suggest that the combined approach should be considered as a treatment option for this population.
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Background. Expert panels of physicians and nonphysicians, all expert in intrathecal (IT) therapies, convened in the years 2000 and 2003 to make recommendations for the rational use of IT analgesics, based on the preclinical and clinical literature known up to those times, presentations of the expert panels, discussions on current practice and standards, and the result of surveys of physicians using IT agents. An expert panel of physicians and nonphysicians has convened in 2007 to update information known regarding IT therapies and to update information on new and novel opioid and nonopioid analgesic compounds that might show promise for IT use. ⋯ Results. The panelists identified several agents that were worthy of future studies for the clinical and rational use of IT agents that are presented in this article. Conclusions. A list of nonopioid IT analgesics, including gabapentin, adenosine, octreotide, the χ-conopeptide, Xen2174, the conopeptide, neurotensis 1 agonist, CGX-1160, the ω-conotoxin, AM-336, and physostigmine, were identified as worthy of future research by the panelists.
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Review Case Reports
An unusual presentation of thoracic cord compression by a dorsal arachnoid cyst in a 14-month-old boy. A discussion of the case and review of the literature.
Spinal arachnoid cysts are a rare cause of spinal cord compression in children and presenting symptoms may be subtle. We present a neurologically intact 14-month-old boy who presented with pain and postural irritability from a thoracic arachnoid cyst.
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Objective. This article aims to present a case of the use of an alternative form of neuromodulation for the treatment of axial back pain associated with postlaminectomy syndrome. Materials and Methods. An elderly patient with long-standing axial back pain in the setting of a prior decompressive laminectomy presented for evaluation and treatment. ⋯ The permanent system consisted of four Medtronic Quad Plus leads, two on each side of midline oriented horizontally over the L4-5 paraspinous muscles. Our patient was ultimately weaned off of all narcotic medications and, at one year follow-up, continues to report > 90% reduction of pain.
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Zh Vopr Neirokhir Im N N Burdenko · Apr 2008
Case Reports[Neuromodulation--controlled analgesia. Criteria for long efficiency].
In the past three decades, there have been cardinal changes in the surgical treatment of chronic pain syndromes. The early used destructive methods have been mostly substituted for surgical neuromodulation techniques. These include: (1) neurostimulation--the electric stimulation (ES) of peripheral nerves, the spinal cord, and brain; (2) intrathecal drug delivery by means of programmed pumps. ⋯ Positive results of chronic ES are observed in the vast majority of patients having good results in the postoperative testing period. Contrary to the current opinion as to worse follow-up results of chronic ES, we have seen positive changes in 5 patients followed up for about 3 years. Thus, by taking into account the high efficiency and minimal invasiveness of neurostimulation, no serious complications, as well as a possibility of improving the effectiveness of ES in a follow-up, this technique may be used as one of the first stages of surgical treatment of patients with neurogenic pain syndrome.