ABSTRACT
Purpose: Central neuropathic pain (CNP) following spinal cord injury (SCI) presents a formidable therapeutic challenge, affecting over 50% of the patients post-SCI. For those who experience CNP, conventional treatments often prove insufficient. Spinal cord stimulation (SCS) emerges as a potential intervention for chronic pain after SCI that is unresponsive to pharmacotherapy and supportive measures. However, the efficacy of SCS in alleviating CNP is notably limited. The objective of our study was to evaluate novel stimulation paradigms in SCS for patients with severe CNP after SCI, based on our extensive experience. Patients and Methods: From a pool of 112 patients treated with SCS for chronic neuropathic pain in the Department of Neurosurgery and Neurology, we selected eight individuals (4 males and 4 females) with CNP for our case series. Burst and high frequency SCS was applied. The assessment involved utilizing the Numeric Rating Scale (NRS), the Neuropathic Pain Symptom Inventory (NPSI), and the EQ-5D quality of life scale before surgery and during a 12-month follow-up period. Results: Over the course of the one-year follow-up, only two patients experienced satisfactory relief from pain, demonstrating the effectiveness of the stimulation. Moreover, high-frequency and burst SCS failed to show improvement in the remaining six patients. Conclusion: Our findings suggest that, despite the incorporation of new stimulation paradigms such as burst stimulation and high-frequency stimulation, SCS does not exhibit significant effectiveness in treating neuropathic pain in patients after SCI. These findings highlight the ongoing challenge of treating CNP and emphasize the importance of investigating alternative therapeutic strategies for this group.
ABSTRACT
OBJECTIVES: Presenting outcomes of patients hospitalised for COVID-19 should be put in context and comparison with other facilities. However, varied methodology applied in published studies can impede or even hinder a reliable comparison. The aim of this study is to share our experience in pandemic management and highlight previously under-reported factors affecting mortality. We present outcomes of COVID-19 treatment in our facility that will allow for an intercentre comparison. We use simple statistical parameters-case fatality ratio (CFR) and length of stay (LOS). SETTING: Large clinical hospital in northern Poland serving over 120 000 patients annually. PARTICIPANTS: Data were collected from patients hospitalised in COVID-19 general and intensive care unit (ICU) isolation wards from November 2020 to June 2021. The sample consisted of 640 patients-250 (39.1 %) were women and 390 (60.9 %) were men, with a median age of 69 (IQR 59-78) years. RESULTS: Values of LOS and CFR were calculated and analysed. Overall CFR for the analysed period was 24.8%, varying from 15.9 % during second quarter 2021 to 34.1% during fourth quarter 2020. The CFR was 23.2% in the general ward and 70.7% in the ICU. All ICU patients required intubation and mechanical ventilation, and 44 (75.9 %) of them developed acute respiratory distress syndrome. The average LOS was 12.6 (±7.5) days. CONCLUSIONS: We highlighted the importance of some of the under-reported factors affecting CFR, LOS and thus, mortality. For further multicentre analysis, we recommend broad analysis of factors affecting mortality in COVID-19 using simple and transparent statistical and clinical parameters.
