[Neuromodulation--controlled analgesia. Criteria for long efficiency].

In the past three decades, there have been cardinal changes in the surgical treatment of chronic pain syndromes. The early used destructive methods have been mostly substituted for surgical neuromodulation techniques. These include: (1) neurostimulation--the electric stimulation (ES) of peripheral nerves, the spinal cord, and brain; (2) intrathecal drug delivery by means of programmed pumps. Neurostimulation techniques are more frequently used in the treatment of no-cancer pain syndromes. Neurostimulation techniques are more frequently used in the treatment of no-cancer pain syndromes. Detailed analysis of our results showed that negative results and all cases with negative changes in follow-up were noted chiefly in patients with obvious and serious deafferentation signs. Testing ES is a major predictor of effectiveness for MCS. Positive results of chronic ES are observed in the vast majority of patients having good results in the postoperative testing period. Contrary to the current opinion as to worse follow-up results of chronic ES, we have seen positive changes in 5 patients followed up for about 3 years. Thus, by taking into account the high efficiency and minimal invasiveness of neurostimulation, no serious complications, as well as a possibility of improving the effectiveness of ES in a follow-up, this technique may be used as one of the first stages of surgical treatment of patients with neurogenic pain syndrome.

[Chronic spinal cord electrostimulation in the management of neurogenic pain].

According to the data of epidemiological surveys made in Russia, the prevalence of chronic pain (without cancer diseases being kept in mind) accounts for less than 40% of the adult population and these figures tend to grow steadily. Despite a continuous increase in the potentialities of pharmacotherapy, physiotherapy, and psychotherapy, the efficiency of treatment in patients suffering from various pains has remained ineffective so far. Surgical treatments for pain include anatomic, destructive (neuroablation), and non-destructive (electrical stimulation and neuromodulation) operations. The purpose of the paper is to present the results of use of chronic spinal cord stimulation in 10 patients (6 males and 4 females) with severe drug-resistant pain. The patients' age was 32 to 74 years (mean 47.2 years). The duration of the pain syndrome before surgery averaged 6 years (3-13 years). The severity of pain and its influence on the quality of life were assessed, by using a modified 10-score visual analogue scale. The operation was performed in 2 steps. The step involved electrode implantation along the Tuochi needle under X-ray control. If there were positive postoperative results, the second stage was implantation of the subcutaneous part of the system for chronic stimulation. Positive (excellent and good) results were obtained in 9 of the patients, excellent results being in 5 patients. The follow-up averaged 18 months (6 to 28 months). The late postoperative positive result remained in 8 patients. Two patients were observed to have complications as displacement of an epidural electrode, which required surgical correction of its position. Resurgery restored the antipain effect of stimulation. Chronic epidural stimulation can be the method of choice in treating neurogenic pain since it is minimally invasive and more effective than other surgical treatments.