Articles: chronic-pain.
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Objective. For patients with refractory angina pectoris, spinal cord stimulation (SCS) is a beneficial and safe adjuvant therapy. However, it has not yet been established whether SCS alters the quality of life (QoL) in these patients. ⋯ QoL in patients with refractory angina pectoris is poor. Both pain and health aspects of QoL improved significantly after 3 months of SCS. Social, mental, and physical aspects of QoL were found improved after 1 year of SCS.
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Objective. The conventional technique used to stimulate the lumbar dermatomes is by stimulation of the dorsal columns of the spinal cord. Until recently, stimulation of nerve roots had not been successfully accomplished. ⋯ Lumbar and sacral NRS trials resulted in adequate paresthesia coverage and effective pain relief in all 5 patients. Further clinical trials to evaluate long-term success rates and safety are indicated. Detailed mapping studies are needed to evaluate the relationship between electrode placement and paresthesia patterns as well as the optimal stimulation parameters.
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Central pain mechanisms are deeply embodied in the psychophysical problem of pain. They are located in the brain and spinal cord and are becoming increasingly recognised as playing a major role in the generation and maintenance of pain and disability associated with neuromusculoskeletal problems. Central mechanisms participate in all pain states, acute and chronic. ⋯ In reality, as key players in the healing process, central mechanisms are profoundly affected by manual therapy even when it is directed at a peripheral problem. Treatment of peripheral mechanisms can be performed through central techniques because both peripheral and central mechanisms are always part of the same clinical problem. Consequently, manual therapy must change its mindset from a peripheral standpoint and integrate central mechanisms into clinical practice as a means of improving therapeutic efficacy and to prevent the descent of acute pain into chronic.
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Objective. To examine the importance of posture on the efficacy of spinal cord stimulation in a population of chronic pain patients previously implanted with a spinal cord stimulator. Materials and Methods. ⋯ The mean range and SD of stimulation required to achieve paresthesia at all three posture levels was found to be 0.113 ± 0.062 μC for leads in the cervical region (N = 11) and 0.494 ± 0.297 μC for leads in the thoracic region (N = 19). Conclusions. To provide adequate stimulation at all postures, multiple stimulation settings (programs) would be required.