Articles: chronic-pain.
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Background. Initially developed to excite peripheral nerves, magnetic stimulation was quickly recognized as a valuable tool to noninvasively activate the cerebral cortex. The subsequent discovery that repetitive transcranial magnetic stimulation (rTMS) could have long-lasting effects on cortical excitability spawned a broad interest in the use of this technique as a new therapeutic method in a variety of neuropsychiatric disorders. Although the current outcomes from initial trials include some conflicting results, initial evidence supports that rTMS might have a therapeutic value in different neurologic conditions. ⋯ Lastly, only two randomized, sham-controlled studies have been performed for epilepsy; although evidence indicates rTMS may reduce seizure frequency in patients with neocortical foci, more research is needed to confirm these initial findings. Conclusions. There is mounting evidence for the efficacy of rTMS in the short-term treatment of certain neurologic conditions. More long-term research is needed in order to properly evaluate the effects of this method in a clinical setting.
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Objectives. A prospective, open label, multicenter clinical trial confirmed the functionality of a new spinal cord stimulation (SCS) system for the treatment of chronic, intractable pain of the trunk and/or limbs. Materials and Methods. Sixty-five subjects tested a rechargeable 16-channel SCS system with individual current control of each contact on one or two percutaneous eight-contact epidural leads. After baseline measurements, subjects were tracked on pain ratings and complication rates for up to 18 months. ⋯ More than one-half the implanted subjects experienced 50% or greater relief of pain after permanent implantation; some subjects reported relief of 90% or more of their pain. The most common complications after permanent implantation were lead migration, uncomfortable stimulation, and component failure; most resolved after reprogramming or device replacement. Conclusions. The new SCS system provided good pain relief to a majority of subjects, and the results confirm a favorable safety and efficacy profile for the SCS system.
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Objective. Our objective was to determine the efficacy of peripheral nerve field stimulation (PNFS) for the treatment of chronic lower back pain. PNFS is becoming increasingly recognized as a safe, minimally invasive, and easily reversible treatment for a variety of chronic pain conditions. Chronic low back pain is a common cause of disability and one that is difficult to treat effectively. ⋯ Results. In each case presented here, PNFS enabled patients to decrease their pain medication and increase their level of activity. The patients all reported reduction in pain as measured by visual analog scale scores and an improved quality of life. Conclusion. We conclude that PNFS is a safe and effective alternative treatment for patients with chronic low back pain, and should be considered in this population.
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Objectives. Electrical brain stimulation is used as a treatment for patients with intractable chronic pain and movement disorders. However, the implantation of electrodes and electrical stimulation may induce histological changes around the electrode tip. We aimed to review the histological changes in humans that were electrically stimulated in the brain. ⋯ Macroscopic lesions were present in only some cases, mostly due to pulling at the extension cable in the postoperative evaluation period preceding definite implantation of the electrode wire and stimulator. Conclusions. Electrical brain stimulation induces histological changes in some patients. According to electrical brain stimulation studies in animals, these changes can be related to the charge and charge density per phase (and their interaction).
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Introduction. Early animal and human evidence existed for a postsynaptic dorsal column (PSDC) pathway for visceral nociception that, when lesioned, decreased pain of terminal illness. There have been recent anecdotal reports in the literature that spinal cord stimulation (SCS) reduces pain of visceral nociception. We present here a review of the literature supporting a hypothesis that SCS might work by modulating information through the spinothalamic tracts (STT) and PSDC. ⋯ Conclusions. Chronic visceral nociception may be secondary to visceral sensitization and hyperalgesia and can be affected by the spinal cord and brain, the "brain-gut" axis. There is preclinical evidence and clinical anecdotes that this nociceptive information is transmitted in the central nervous system through the PSDC pathway and LSTT and that SCS decreases pain of visceral nociception. It may be that SCS works by modulation of the above pathways.