Multiple Program Spinal Cord Stimulation in the Treatment of Chronic Pain: Follow-Up of Multiple Program SCS.

Objective. Follow-up of 80 patients using multiple program spinal cord stimulation (SCS). Methods. For 30 months, we followed 80 chronic pain patients who had undergone SCS implantations at our center. Thirty-six patients had Failed Back Surgery Syndrome (FBSS). Patients were evaluated in patient-controlled stimulation mode (patients can select one of several specific programs in response to their activities and pain level). We collected visual analog pain scores, patient satisfaction scores, pain maps, and paresthesia maps. Results. We previously reported our preliminary findings (Neuromodulation 1998;1 :30-45). At 24 months all patients were using more than one program. At 30 months, 62 patients (76%) were using more than two programs as their preferred stimulation mode and three patients (4%) were satisfied with only one stimulation program. At 30 months all patients chose patient-controlled stimulation as their preferred mode of stimulation. A total of 18 patients (23%) were explanted. Mean pain scores declined from 8.2 at baseline to 4.8 (p < 0.05, n= 79). Paresthesia overlap was 91% (n= 79). Of the patients with FBSS, 81% reported that they were using their SCS daily. Conclusions. In spinal cord stimulation the use of multiple electrodes and multiple stimulation programs, together with advanced programmability, increases paresthesia overlap, reduces pain scores, and may improve patient satisfaction with SCS therapy. This study indicates a significant patient preference for multiple program SCS, if patients are given the option to choose between a single program SCS system or a multiple program SCS system.

Computer assisted and patient interactive programming of dual octrode spinal cord stimulation in the treatment of chronic pain.

Objective. To evaluate the effectiveness of spinal cord stimulation using multiple independent programmable electrode selections compared to simple continuous stimulation. Design. Prospective case series 2 years. Setting. Ambulatory care center. Patients. All chronic pain patients who underwent spinal cord stimulation treatment at our center from February 1995 until October 1996 entered the study as a consecutive sample (n = 80). Interventions. Patients were evaluated in continuous stimulation mode (single stimulation program) vs. multi-stimulation mode, (patients activate a series of stimulation programs simultaneously to cover all of their pain) and patient-controlled stimulation mode (patients can select a program in response to their activities and pain level). Outcome measures. We collected visual analog pain scores, patient satisfaction scores by stimulation mode, and paresthesia maps. Results. Mean pain scores declined from 8.1 at baseline to 4.6 with continuous stimulation, and to 3.1 with multi-stimulation and with patient-controlled stimulation (p<0.05). Paresthesia overlap improved from 74% with continuous stimulation to 91% with multi-stimulation, and to 89% with patient-controlled stimulation (p<0.05). None of the patients selected continuous stimulation. Thirty-two patients preferred multi-stimulation, and 48 patients preferred patient-controlled stimulation. Lead revision rates declined from 15% in our previous experience using continuous stimulation to 3.8%. Conclusions. Continuous stimulation was not selected by any patient in favor of multi-stimulation or patient-controlled stimulation. This study indicates that in spinal cord stimulation the use of multiple electrodes together with advanced programmability increases paresthesia overlap, reduces pain scores, reduces revision rates, and improves patient satisfaction with spinal cord stimulation therapy.

Magnetic resonance imaging of hyperbaric oxygen treated rats with spinal cord injury: preliminary studies.

Magnetic resonance imaging (MRI) has been performed to assess the efficacy of hyperbaric oxygen (HBO) treatment on experimental spinal cord injury in a rat animal model. A moderately severe injury, similar to Type III injury seen in humans (Kulkarni et al. Radiology 164:837;1987) has been chosen for these studies. An improvement in the neurologic recovery (based on Tarlov scale) has been observed following HBO treatment over a period of 72 hr. Based on MRI, HBO treatment appears to arrest the spread of hemorrhage and resolve edema.

Psychotropic drug-related suicides.

This study examined the 92 suicides investigated by the Medical Examiner's Office in Rhode Island between 1975 and 1982, in which either tranquilizers or antidepressant drugs were present in the body fluids or tissues of the deceased. We found that traumatic suicides were more prevalent among the tranquilizer victims and that tranquilizers were combined more often with alcohol and other drugs. While the antidepressants were obtained by prescription more often than the tranquilizers, the latter were prescribed by a wider variety of doctors. More antidepressant than tranquilizer suicide victims had a history of psychiatric hospitalization and had previously attempted suicide or spoken of it prior to their death. Our findings also seem to indicate that the antidepressant victims took more time and effort in both contemplating and planning their suicides.