Dorsal column stimulation for control of pain

✓ Thirty patients with chronic intractable pain have had dorsal column implants and a trial of subsequent electrical self-stimulation to relieve the pain. Burning pain originating from damage to the CNS was most often relieved, while chronic bone, joint, and disc pain responded less well. Patients with severe psychiatric factors should be excluded, but preoperative selection is still difficult because of the lack of objective clinical tests. The long-term effect of the implant on the tissues of the dorsal column is still unknown and requires further evaluation. Although relief of pain has been reported for as long as 3 years, much longer follow-ups are necessary to evaluate the efficiency of this system in patients with chronic pain. Direct stimulation of the spinal cord raises a number of interesting questions in regard to perception and sensory phenomena in man but, as yet, there are no answers as to how dorsal column stimulation effects its relief of pain.

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Preliminary percutaneous dorsal column stimulation prior to permanent implantation

Journal of Neurosurgery ◽

10.3171/jns.1972.37.2.0242 ◽

1972 ◽

Vol 37 (2) ◽

pp. 242-245 ◽

Cited By ~ 49

Author(s):

Yoshio Hosobuchi ◽

John E. Adams ◽

Philip R. Weinstein

Keyword(s):

Dorsal Column ◽

Screening Procedure ◽

Intractable Pain ◽

Content Type ◽

Dorsal Column Stimulation ◽

Fine Print

✓ Percutaneous dorsal column stimulation was done as a screening procedure in 34 candidates before implantation of a permanent dorsal column stimulator for the treatment of intractable pain. This procedure was useful in forecasting the tolerance of the patient to the “vibratory sensation” produced by a dorsal column stimulator, and the efficacy of the device in relieving pain. Eight patients termed the “vibratory sensation” intolerable. Sixteen found it unpleasant but preferable to the pain, and two found it actually pleasant.

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Percutaneous epidural stimulation of the spinal cord for relief of pain

Journal of Neurosurgery ◽

10.3171/jns.1978.48.3.0323 ◽

1978 ◽

Vol 48 (3) ◽

pp. 323-328 ◽

Cited By ~ 65

Author(s):

Bruno J. Urban ◽

Blaine S. Nashold

Keyword(s):

Spinal Cord ◽

Dorsal Column ◽

Long Term Results ◽

Percutaneous Technique ◽

Intractable Pain ◽

Epidural Stimulation ◽

Content Type ◽

Major Operation ◽

Stimulation Of

✓ Percutaneous epidural stimulation of the spinal cord was carried out in 20 patients with intractable pain. The procedure proved simple, and no major complications were encountered. The long-term results were comparable to the results obtained after a dorsal column stimulator implant by laminectomy. The percutaneous technique allowed extended trial stimulation without committing the patient to a major operation. Those patients in whom stimulation did not alleviate pain could be identified during a 2-week observation period, and the system could be removed easily. Seven patients were placed on chronic autostimulation and only one of those failed to experience continuing pain relief throughout the follow-up time of up to 2 years. It is concluded that percutaneous epidural stimulation constitutes a valid alternative to dorsal column stimulator implantation.

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Spinal Epidural Neurostimulation for Treatment of Acute and Chronic Intractable Pain

Neurosurgery ◽

10.1227/00006123-197909000-00007 ◽

1979 ◽

Vol 5 (3) ◽

pp. 344-348 ◽

Cited By ~ 34

Author(s):

Robert R. Richardson ◽

Edir B. Siqueira ◽

Leonard J. Cerullo

Keyword(s):

Pain Relief ◽

Dorsal Column ◽

Therapeutic Modality ◽

Intractable Pain ◽

Significant Pain ◽

Long Term Follow Up ◽

Post Traumatic ◽

Spinal Epidural ◽

Dorsal Column Stimulation

Abstract Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Nashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

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Pain reduction in amputees by long-term spinal cord stimulation

Journal of Neurosurgery ◽

10.3171/jns.1980.52.3.0346 ◽

1980 ◽

Vol 52 (3) ◽

pp. 346-350 ◽

Cited By ~ 108

Author(s):

Jörg-Ulrich Krainick ◽

Uwe Thoden ◽

Traugott Riechert

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Pain Reduction ◽

Dorsal Column ◽

Content Type ◽

Follow Up Study ◽

Dorsal Column Stimulation ◽

Fine Print

✓ This follow-up study analyzes the results of dorsal column stimulation instituted between 1972 and 1974 for the relief of pain in 84 patients, including 64 amputees. Good results decreased from 52.4% after 2 years of stimulation to 39% after 5 years. Special therapeutic problems in amputees are discussed.

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Evaluation of Dorsal Column Stimulation in the Treatment of Chronic Pain

Neurosurgery ◽

10.1097/00006123-197811000-00008 ◽

1978 ◽

Vol 3 (3) ◽

pp. 373-379 ◽

Cited By ~ 1

Author(s):

Ronald F. Young

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Dorsal Column ◽

Electrode Placement ◽

Intractable Pain ◽

Technical Problems ◽

Electrode Implantation ◽

Complete Pain Relief ◽

Cord Injury ◽

Dorsal Column Stimulation

Abstract Dorsal column stimulation (DCS) was used in the treatment of chronic intractable pain in 51 patients. Twenty-five of the patients had back and leg pain secondary to the treatment of intervertebral disc disease; 11 had postoperative pain after general or thoracic surgical procedures. The remainder suffered pain related to multiple sclerosis, spinal cord injury, carcinoma, and peripheral vascular disease. Pain had been present for a mean of 24 months. Thirty-seven patients underwent DCS electrode placement by open laminectomy, and 11 had percutaneous epidural DCS electrode placement. Three patients first underwent epidural DCS electrode implantation and subsequently had DCS electrode implantation by laminectomy. No major complications were noted, although multiple lesser complications required 33 additional operative procedures for correction. Follow-up periods ranged from 12 to 67 months, with a mean of 38 months. Immediately after implantation. 47% of the patients reported that they had essentially complete pain relief, but 3 years later this had decreased to 8%. No patient followed for 4 years or longer reported complete pain relief. Thirty-three per cent of the patients discontinued the regular use of narcotics for pain relief after DCS electrode implantation. Unfortunately, only 16% were able to return to gainful employment or full physical activity after DCS. Based on these data and a review of the literature, the following conclusions are made: (a) assessment of success in the treatment of chronic pain is strongly dependent on the criteria used for patient evaluation: (b) with the criteria of this report, DCS is a relatively ineffective treatment for chronic pain; (c) epidural percutaneous DCS systems are no more effective than are those placed by laminectomy, and, because of technical problems with epidural systems (mainly lead breakage and migration), the latter may actually be less effective; and (d) at present DCS seems to play a minor role in the treatment of chronic intractable pain.

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Distribution of activity in spinal pathways evoked by experimental dorsal column stimulation

Journal of Neurosurgery ◽

10.3171/jns.1975.42.3.0290 ◽

1975 ◽

Vol 42 (3) ◽

pp. 290-295 ◽

Cited By ~ 20

Author(s):

Heinrich Bantli ◽

James R. Bloedel ◽

Donlin M. Long ◽

Phudhiphorn Thienprasit

Keyword(s):

Rhesus Monkeys ◽

Dorsal Column ◽

Electrode Position ◽

Content Type ◽

Spinal Pathways ◽

Therapeutic Value ◽

Stimulus Parameters ◽

Different Characteristics ◽

Dorsal Column Stimulation ◽

Fine Print

✓ Experiments were performed in rhesus monkeys to determine the distribution of activity evoked in spinal pathways by dorsal column stimulation. It was shown that many pathways in both the dorsal and ventral quadrants of the cord can be activated either directly or transsynaptically by stimulation with electrodes of the type implanted clinically. Moreover, the transsynaptically evoked responses recorded in each quadrant had somewhat different characteristics. Therefore, since the activation of each group of pathways may have differing effects in modifying the perception of noxious stimuli, the authors believe that changes in electrode position and stimulus parameters may be important in obtaining the therapeutic value of spinal cord stimulation for relief of pain.

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Using the ARDL-ECM approach to investigate the nexus between support price and wheat production

Journal of Asian Business and Economic Studies ◽

10.1108/jabes-10-2018-0084 ◽

2019 ◽

Vol 26 (1) ◽

pp. 139-152

Author(s):

Abbas Ali Chandio ◽

Yuansheng Jiang ◽

Abdul Rehman

Keyword(s):

Bounds Testing ◽

Content Type ◽

Wheat Production ◽

Long Run ◽

Long Term Effect ◽

Ardl Approach ◽

Support Price ◽

Short Run ◽

Effect Of Support

PurposeThe purpose of this paper is to examine the effect of support price on wheat production in Pakistan during the period 1971–2016.Design/methodology/approachTo capture the effect of support price on wheat production, the authors estimated the long-run linkage by using the ARDL bounds testing approach to cointegration.FindingsThis study confirmed the presence of a positive and long-term effect of area under cultivation, support price and fertilizer consumption on wheat production through ARDL bounds test. The results showed that both in the long run and short run, support price plays an important role in the enhancement of wheat production. The authors also found that the coefficients of the area under cultivation and fertilizer consumption variables were statistically significant and positive both in the long run and short run.Originality/valueThe use of the ARDL approach that examines the long-run and short-run effects of support price on wheat production in Pakistan makes the current study unique. An emerging economic literature suggests that only limited research has been conducted in this area.

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Leadership style and the process of organizational change

Leadership & Organization Development Journal ◽

10.1108/lodj-11-2012-0155 ◽

2015 ◽

Vol 36 (1) ◽

pp. 2-16 ◽

Cited By ~ 25

Author(s):

Ann-Louise Holten ◽

Sten Olof Brenner

Keyword(s):

Leadership Styles ◽

Transactional Leadership ◽

Leadership Style ◽

Structural Equation ◽

Content Type ◽

Long Term Effect ◽

Transformational And Transactional Leadership ◽

Using Data ◽

Reactions To Change

Purpose – The purpose of this paper is to identify processes which may contribute to followers’ positive reactions to change. By focusing on the relationship between change antecedents and explicit reactions, the authors investigate the direct and indirect relationships between leadership styles (transformational and transactional) and followers’ appraisal of change through manager engagement. Design/methodology/approach – Using data from a longitudinal survey among 351 followers in two Danish organizations, the study tracked the planned implementation of team organization at two different times. Data were analyzed using structural equation modelling. Findings – Transformational and transactional leadership styles were positively related to the engagement of managers. Managers’ engagement was associated with followers’ appraisal of change. The two leadership styles also had a direct, long-term effect on followers’ change appraisal; positive for transformational leadership and negative for transactional leadership. Practical implications – The results have potential implications for change management, as followers’ change appraisal may be improved by developing managers’ leadership style and engagement. Originality/value – This is the first study to provide longitudinal evidence of the direct and indirect effects of leadership styles on followers’ change appraisal.

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Intraoperative evoked potentials recorded in man directly from dorsal roots and spinal cord

Journal of Neurosurgery ◽

10.3171/jns.1985.62.5.0680 ◽

1985 ◽

Vol 62 (5) ◽

pp. 680-693 ◽

Cited By ~ 30

Author(s):

Blaine S. Nashold ◽

Janice Ovelmen-Levitt ◽

Robbin Sharpe ◽

Alfred C. Higgins

Keyword(s):

Spinal Cord ◽

Dorsal Root ◽

Mean Amplitude ◽

Dorsal Column ◽

Intractable Pain ◽

Neurosurgical Procedures ◽

Negative Wave ◽

Content Type ◽

Root Entry Zone ◽

Dorsal Columns

✓ Direct spinal cord surface recordings of evoked spinal cord potentials have been made in 26 patients during neurosurgical procedures for intractable pain. Monopolar recordings at the dorsal root entry zone after peripheral nerve stimulation have been made at multiple levels for segmental localization and to monitor the state of the afferent path and dorsal horn. Dorsal root and dorsal column conduction has been tested on diseased and intact sides. Normal afferent conduction velocity was found to have an overall mean of 61.33 m/sec for cervicothoracic and lumbosacral peripheral nerves, and 50 m/sec for the dorsal columns. The normal mean amplitude for the slow negative wave (N1) recorded at the root entry was 52.54 µV, while that for the dorsal column conducted response recorded within 4 cm of the stimulus point on the dorsal columns was 347.5 µV. Several different placements of stimulating and recording electrodes are described, as well as their application. An interpretation of the resulting data is proposed.

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