Articles: neuropathic-pain.
-
Spinal cord stimulation is the most common mode of neuromodulation used in managing chronic low back pain. It is minimally invasive and reversible as opposed to nerve ablation. The basic scientific background of the initial spinal cord stimulation trials was based on the gate control theory of Melzack and Wall. ⋯ There is substantial scientific evidence on the efficacy of spinal cord stimulation for treatment of low back and lower extremity pain of neuropathic nature. Clinical studies revealed a success rate of from 50% to 70% with spinal cord stimulation, with decreased pain intensity scores, functional improvement and decreased medication usage. This review discusses multiple aspects of spinal cord stimulation, including pathophysiology and mechanism of action, rationale, indications, technique, clinical effectiveness, and controversial aspects.
-
Patients who do not improve after lumbar surgery may be given the nonspecific label of "failed back surgery syndrome (FBSS)." Since 1981, there has not been a quantitative assessment of the etiologies of FBSS despite major improvements in surgical techniques and diagnostic testing. ⋯ We were able to establish a predominant diagnosis in 94% of our patients. Foraminal stenosis remains the leading cause of FBSS, but painful discs are also common. Recurrent disc herniation is seen less often than in the past, and there is increased recognition of neuropathic pain. Knowledge of the potential causes of FBSS leads to a more efficient and cost-effective evaluation of these patients.
-
The aim of this work is to assess quality of treatment and to monitor drawbacks of SCS implantation systems through a National Observational Center. Data were obtained through a questionnaire sent by post or via telephone to each patient. All patients were affected by chronic-'vascular' and "neuropathic" pain. ⋯ We conclude that the methodology used is consistent with that of previous studies on nonmalignant chronic pain. The data obtained also reveal implantation hardware reliability, regardless of clinical outcome. A low percentage of complications and a high degree of patient satisfaction are also to be stressed.
-
Antiepileptic drugs were initially designed to treat epileptic seizures, but are increasingly used in the treatment of neuropathic pain. Efficacy of the newer antiepileptic drugs has been confirmed in placebo-controlled studies for trigeminal neuralgia, postherpetic neuralgia, painful polyneuropathy and central poststroke pain. ⋯ These mechanisms could account for their antiallodynic and antihyperalgesic effects demonstrated in animal models of neuropathic pain and also suggested for gabapentin and lamotrigine in humans. Additional studies are required to compare efficacy of newer versus standard antiepileptic drugs and to better define their place in comparison with other analgesics in the treatment of neuropathic pain.
-
Alpha(2) agonists have been in clinical use for decades, primarily in the treatment of hypertension. In recent years, alpha(2) agonists have found wider application, particularly in the fields of anesthesia and pain management. It has been noted that these agents can enhance analgesia provided by traditional analgesics, such as opiates, and may result in opiate-sparing effects. ⋯ The clinical utility of these agents is ever expanding, as they are gaining broader use in neuraxial analgesia, and new applications are continuously under investigation. The alpha(2) agonists that are currently employed in anesthesia and pain management include clonidine, tizanidine, and dexmedetomidine. Moxonidine and radolmidine, which are not currently in clinical use in humans, may offer favorable side-effect profiles when compared with traditional alpha(2) agonists, and may thereby allow for more widespread pain management applications.