ABSTRACT
Over the past four decades, techniques and devices for spinal cord stimulation have undergone considerable refinement. Currently, percutaneous implantable electrodes are placed in the epidural space and a low-frequency electrical current is used to modify the transmission of chronic pain signals in the dorsal columns of the spinal cord. Before permanent implantation, the spinal cord stimulation will be examined during a test phase to determine its analgesic effect and tolerability. We have reviewed our experience in 88 patients with chronic nonmalignant pain. The follow-up of our study ranged from 15 to 75 months, with an average of 60 months. The indication for SCS in these 88 patients was mainly neuropathic pain syndromes. The patients were followed up by the Visual Analog Scale (VAS), level of activity and subjective assessment of the quality of life. On the basis of the patients' self-assessments using the VAS, the degree of pain relief was excellent/good in 72 of 88 patients (82%). At the end of the follow-up period, 50% of the patients were in a better psychological status and 86% of the patients reported an improvement in activities of their daily living and a reduction in the use of analgesic medication. Ninety percent of the patients stated that they would go through the procedure again for the same result. The findings of the present study indicate that spinal cord stimulation is an efficacious therapy for the treatment of chronic non-malignant pain.
Subject(s)
Electric Stimulation Therapy/methods , Pain/surgery , Spinal Cord/physiology , Chronic Disease , Dose-Response Relationship, Radiation , Electric Stimulation Therapy/instrumentation , Electrodes, Implanted , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Retrospective StudiesABSTRACT
Intraspinal drug infusion using implantable pumps and catheter systems is a safe and effective therapy for selected pain patients with severe chronic pain. It improves pain relief, reduces drug-related side effects, decreases the need for oral analgesia and enhances quality of life in a segment of chronic pain patients whose pain has not been controlled with more conservative therapies. Intrathecal drug therapy has therefore established its role in the treatment of malignant pain, benign pain and severe spasticity.Careful patient selection and management as well as a multidisciplinary approach are determinants of successful treatment. Current practices for patient selection and management, screening, drug selection, dosing and implantation for intrathecal drug delivery systems are discussed.
Subject(s)
Analgesia, Epidural/methods , Pain/drug therapy , Analgesia, Epidural/psychology , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Animals , Chronic Disease , Humans , Infusion Pumps, Implantable/psychology , Muscle Spasticity/drug therapy , Muscle Spasticity/psychology , Pain/psychology , Pain Measurement/psychology , Quality of Life/psychologyABSTRACT
Experiences with long-term intraspinal infusion of opioid drugs using the new implantable medication pump VIP 30 in patients with chronic non-malignant pain are reported. During a 19-month period 10 patients with chronic pain--mainly mixed nociceptive-neuropathic pain--underwent implantation of the medication pump for long-term treatment. The mean follow-up period was 9.5 months. Pain relief was classified as very good in 22.2%, good in 44.4%, moderate in 22.2% and poor in 11.1%. In 88.9% of the cases the patients stated they would undergo the same procedure again. Technical problems (catheter dislocation) developed in 1/10 patients could be surgically corrected. One pump including catheter was explanted because of an infected seroma within the pocket area. Long-term intrathecal application of opioids with the VIP 30 pumps is an effective and safe treatment in patients with chronic non-malignant pain.
Subject(s)
Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Adult , Aged , Analgesics, Opioid/therapeutic use , Female , Follow-Up Studies , Humans , Infusion Pumps, Implantable , Injections, Spinal , Long-Term Care , Male , Middle Aged , Morphine/therapeutic use , Pain/drug therapy , Pain MeasurementABSTRACT
From January 1, 1986, to June 30, 1996, 240 patients were operated on for trigeminal neuralgia: 182 patients were treated by thermocoagulation of the gasserian ganglion after Sweet and 58 patients by decompression of the trigeminal nerve after Janetta. In the thermocoagulation group, followed up for 6 months to 10 years 95.2% of the cases showed freedom from pain, in the Janetta operation group, followed up for 6 months to 6 years 98.5% showed freedom from pain. Thermocoagulation is the preferred therapy, especially in older patients in whom general anesthesia is risky, while the Janetta operation is the therapy of choice in younger patients.
