Burst Spinal Cord Stimulation: Introduction to a New Age in Neuromodulation

2016 ◽  
Author(s):  
Timothy R. Deer ◽  
Jason E. Pope ◽  
Eric T. Lee ◽  
Corey W. Hunter
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Invasive Procedure ◽  
Pain Medicine ◽  
Minimally Invasive Procedure ◽  
Pain Pathway ◽  
The World ◽  
Recent Developments ◽  
Tonic Stimulation

Spinal cord neuromodulation has been a long-established treatment option for those suffering from various types of chronic pain. This minimally invasive procedure provides the potential for long-term pain relief, reducing the burden of other types of therapy, such as medications. As with any medical treatment, some patients do not tolerate or respond well to the therapy. This fact has led to recent developments in the technology to improve the therapeutic efficacy. More specifically, in 2010, Dr. Dirk De Ritter described what is known as burst waveforms, which may result in better outcomes than traditional tonic stimulation, which is most commonly used in clinically. An understanding of the mechanism of neuromodulation and how these waveforms disrupt different targets in the pain pathway therefore represents a significant advancement in the world of interventional pain medicine. This evolution of treatment may improve the lives of those suffering from lifelong pain conditions and chronic pain states.

Long-term effects of spinal cord stimulation in chronic pain syndromes

1986 ◽  
Vol 233 (1) ◽  
pp. 16-18 ◽  
Author(s):  
H. P. Vogel ◽  
B. Heppner ◽  
N. H�mbs ◽  
J. Schramm ◽  
C. Wagner
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
Long Term Effects ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

scholarly journals Lack of correlation between spinal microgliosis and long-term development of tactile hypersensitivity in two different sciatic nerve crush injury

2021 ◽  
Vol 17 ◽  
pp. 174480692110113
Author(s):  
Hyoung Woo Kim ◽  
Chan Hee Won ◽  
Seog Bae Oh
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Sensory Function ◽  
Crush Injury ◽  
Sciatic Nerve Crush

Microglia activation following peripheral nerve injury has been shown to contribute to central sensitization of the spinal cord for the development of neuropathic pain. In a recent study, we reported that the amount of nerve damage does not necessarily correlate with chronic pain development. Here we compared the response of spinal microglia, using immunohistochemistry as a surrogate of microglial activation, in mice with two different types of crush injury of the sciatic nerve. We confirmed that incomplete crush of the sciatic nerve (partial crush injury, PCI) resulted in tactile hypersensitivity after the recovery of sensory function (15 days after surgery), whereas the hypersensitivity was not observed after the complete crush (full crush injury, FCI). We observed that immunoreactivity for Iba-1, a microglial marker, was greater in the ipsilateral dorsal horn of lumbar (L4) spinal cord of mice 2 days after FCI compared to PCI, positively correlating with the intensity of crush injury. Ipsilateral Iba-1 reactivity was comparable between injuries at 7 days with a significant increase compared to the contralateral side. By day 15 after injury, ipsilateral Iba-1 immunoreactivity was much reduced compared to day 7 and was not different between the groups. Our results suggest that the magnitude of the early microgliosis is dependent on injury severity, but does not necessarily correlate with the long-term development of chronic pain-like hypersensitivity after peripheral nerve injury.

scholarly journals Long-term follow-up of intraocular pressure and pressure-lowering medication in patients following Excimer laser trabeculotomy

2020 ◽  
Author(s):  
C. Deubel ◽  
D. Böhringer ◽  
A. Anton ◽  
T. Reinhard ◽  
J. Lübke
Keyword(s):  
Intraocular Pressure ◽  
Minimally Invasive ◽  
Cataract Surgery ◽  
Excimer Laser ◽  
Invasive Procedure ◽  
Minimally Invasive Procedure ◽  
Long Term Follow Up ◽  
Excimer Laser Trabeculotomy

Abstract Background Excimer laser trabeculotomy (ELT) is a minimally invasive procedure to lower the intraocular pressure (IOP) via a photo-ablative laser that is applied to the trabecular meshwork. With this procedure, it is possible to improve the outflow of the aqueous humor. Until now, a limited number of studies examining mostly relatively small sample sizes with midterm follow-up exist. We therefore present the analysis of a large ELT cohort in a long-term follow-up. Methods We recorded data from 580 patients who underwent ELT or combined ELT with cataract surgery at our institution from November 2000 until March 2011. A total of 512 patients with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and ocular hypertension (OHT) were included in the analysis. At every follow-up examination, the usage of IOP-lowering medication and the IOP were recorded. Failure criteria were defined as the need for another surgical glaucoma procedure, when the IOP was not 21 mmHg or less and a reduction of 20% from the baseline was not achieved with (qualified success) or without (absolute success) additional medication. Statistical analysis was done using Kaplan-Meier analysis and Cox regression. Results Four hundred twenty-eight patients underwent combined cataract and ELT surgery, and 84 underwent solitary ELT surgery. After a median follow-up time of 656 days, 87% (combined surgery) and 66% (ELT) of the patients did not have to undergo another IOP-lowering intervention; 47/31% were classified as a qualified success and 31/11% as a complete success. The IOP-lowering medication, however, could not be significantly reduced within that time period. Conclusion Especially when combined with cataract surgery, ELT is a feasible minimally invasive procedure to lower the IOP on a mid- to long-term basis. Over the long term, however, IOP-lowering medication could not be reduced.

scholarly journals Five Centuries of Regional Development in Northwest Germany and the Netherlands

2011 ◽  
pp. 199-217
Author(s):  
Kees Terlouw
Keyword(s):  
The Netherlands ◽  
Regional Development ◽  
Urban Population ◽  
World System ◽  
Northwest Germany ◽  
German Regions ◽  
The World ◽  
Recent Developments ◽  
Developmental Opportunities

Germany and the Netherlands have developed very differently over the centuries. A closeexamination of Dutch and German regions show the differentiated way in which regions profitfrom the changing developmental opportunities of the world-system. This article studies long-term regional development using regional urban population in the Netherlands and NorthwestGermany. Initially the coastal regions profited from the emerging trade based agricultural world-system. Later on, state formation enabled some of the previously developed regions to regaintheir position. Industrialization concentrated the development. In recent times, developmentspreads, giving developmental opportunities to some previously disadvantaged regions that arewell located and well-endowed to profit from the recent developments in the world-system.

scholarly journals Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 193-201
Author(s):  
Syed M Adil ◽  
Lefko T Charalambous ◽  
Charis A Spears ◽  
Musa Kiyani ◽  
Sarah E Hodges ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Dose Reduction ◽  
Spinal Cord Stimulation ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Patient Centered ◽  
Opioid Dose ◽  
The Impact

Abstract BACKGROUND Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs. OBJECTIVE To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction. METHODS The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME). RESULTS A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P < .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P < .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01). CONCLUSION Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.

scholarly journals Acupuncture's Effects in Treating the Sequelae of Acute and Chronic Spinal Cord Injuries: A Review of Allopathic and Traditional Chinese Medicine Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Peter T. Dorsher ◽  
Peter M. McIntosh
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Spinal Cord Injuries ◽  
The United States ◽  
Sensory Loss ◽  
Term Survival ◽  
Cord Injury

Each year, there are an estimated 12 000 individuals who sustain a spinal cord injury (SCI) in the United States. Improved understanding of the pathophysiology of SCI and its sequelae has over the past 50 years led to the development of medical treatments (especially urologic) that have enhanced short- and long-term survival from these injuries. The prevalence of individuals with SCI in this country is ~250 000 individuals; and beyond the incalculable personal consequences of these devastating neurologic injuries, substantial direct and indirect societal costs result from the sequelae of SCI including paralysis, sensory loss, chronic pain, decubiti and bladder and/or bowel incontinence. The purpose of this treatise is to review the allopathic and traditional Chinese medicine (TCM) literature available through MEDLINE, PubMed and eCAM search engines that discuss the potential uses of acupuncture to treat acute and chronic spinal cord injuries and their sequelae, and present the neurophysiologic mechanisms for acupuncture's beneficial effects. There is evidence that use of electroacupuncture in acute SCI may significantly improve long-term neurologic recovery from these injuries both in terms of motor, sensory and bowel/bladder function with essentially no risk. Acupuncture may even improve neurourologic function in individuals with chronic SCI, and help with management with chronic pain associated with these injuries.

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