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Neurosurgical treatment for chronic pain

Adrian B Levine, Andrew G Parrent, Keith W MacDougall
BACKGROUND: Chronic neuropathic groin pain is a common problem. It can arise following surgery or trauma, or spontaneously as part of various pelvic pain syndromes. A number of different stimulation techniques have been reported in the literature to treat this area, but due to the complex anatomy of the region, it can be difficult to target effectively with paresthesias. OBJECTIVES: In this study we report our results treating patients with chronic neuropathic groin, pelvic, and abdominal pain, using spinal cord stimulation and dorsal nerve root stimulation...
July 2016: Pain Physician
Martin Jakobs, Andreas Unterberg, Rolf-Detlef Treede, Sigrid Schuh-Hofer, Rezvan Ahmadi
BACKGROUND: Neurosurgical pain management of drug-resistant trigeminal neuralgia (TN) is highly challenging. Microvascular decompression is a first-line neurosurgical approach for classical TN with neurovascular conflict, but can show clinical relapse despite proper decompression. Second-line destructive techniques like radiofrequency thermocoagulation have become reluctantly used due to their potential for irreversible side effects. Subcutaneous peripheral nerve field stimulation (sPNFS) is a minimally invasive neuromodulatory technique which has been shown to be effective for chronic localised pain conditions...
September 2016: Acta Neurochirurgica
Rory J Piper, Mark A Hughes, Carmel M Moran, Jothy Kandasamy
Focused ultrasound (FUS) is an incision-less intervention that is a Food and Drug Association (FDA) approved surgical treatment for various pathologies including uterine fibroids and bone metastases. Recent advances in magnetic resonance imaging thermometry and ability to use FUS across the intact calvarium have re-opened interest in the use of FUS in the treatment of neurological diseases. FUS currently has a European CE mark for use in movement disorders. However, it shows potential in the treatment of other neuropathologies including tumours and as a lesional tool in epilepsy...
June 2016: British Journal of Neurosurgery
Kunal Gupta, Kim J Burchiel
BACKGROUND: Pain is a very commonly reported symptom and often drives patients to seek medical attention; however, it can prove a very difficult diagnostic conundrum and even more challenging to treat effectively. Accurately determining the primary pain generator is key, as certain conditions have efficacious medical and surgical treatments. We present a rare case of a man with multiple sclerosis presenting with spinal cord seizures causing dermatomal pain. While pain has been reported in the context of motor symptoms attributed to spinal cord seizures in a small number of spinal cord conditions, this case represents the first report of pain exclusively associated with spinal cord demyelination in multiple sclerosis...
2016: Journal of Medical Case Reports
E D Isagulyan, A A Tomsky, A V Dekopov, E M Salova, E M Troshina, E V Dorokhov, V A Shabalov
AIM: The article is aimed to demonstrate our experience in motor cortex stimulation (MCS) in patients with chronic neuropathic pain syndromes, assess the clinical efficacy of the technique in short-term and long-term follow-up, and analyze potential predictors of the MCS efficacy. MATERIAL AND METHODS: Twenty patients were implanted with MCS electrodes at the Burdenko Neurosurgical Institute in the period between 2004 and 2014. The mean age of patients was 52 years (26 to 74 years)...
2015: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Ido Strauss, Karim Taha, Vibhor Krishna, Mojgan Hodaie
BACKGROUND: Spinal cord stimulation (SCS) is an accepted surgical treatment for neuropathic pain in failed back syndrome or complex regional pain syndrome. However, even in the best selected surgical cases the predictors of adequate pain control are not well defined. The aim of this study was to identify predictors of outcome in patients who underwent SCS in our center. METHODS: We performed a retrospective analysis of our neurosurgical database for patients who underwent SCS over the last 8 years in an attempt to identify factors predictive of outcome...
May 2016: Acta Neurochirurgica
Mayur Sharma, Vikas Naik, Milind Deogaonkar
Deep brain stimulation (DBS) implantation surgery is an established treatment modality for a variety of medical refractory movement disorders such as Parkinson's disease, essential tremors and dystonia. Following the success of DBS in these movement disorders with a high rate of safety and efficacy, there is a resurgence of interest in the utility of this modality in other medical refractory disorders. Consequently, neuromodulation has been explored for a variety of refractory conditions such as neuropsychiatric disorders (major depressive disorders, obsessive-compulsive disorders, addictions), eating disorders including obesity, traumatic brain injury, post-traumatic stress disorders (PTSD), dementias and chronic pain...
June 2016: Journal of Neurosurgical Sciences
Sandra G J Boccard, Erlick A C Pereira, Tipu Z Aziz
Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex...
October 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Catalina Granada, Meredith Loveless, Tiffany Justice, Thomas Moriarty, Ian Mutchnick, Jennifer E Dietrich, A Scott LaJoie, Paige Hertweck
STUDY OBJECTIVE: To describe how pediatric and adolescent patients present to the gynecologist when they have tethered cord syndrome (TCS). DESIGN: We conducted a retrospective chart review on all patients suspected by the gynecologist of having TCS. SETTING: Single pediatric and adolescent gynecology clinic in a mid-sized city in the midwest. PARTICIPANTS: Thirty-two patients, first seen between 2005 and 2012, suspected of having TCS and for whom follow-up information was available...
October 2015: Journal of Pediatric and Adolescent Gynecology
Michel Wager, Philippe Rigoard, Benoit Bataille, Claude Guenot, Aurélie Supiot, Jean-Luc Blanc, Veronique Stal, Claudette Pluchon, Coline Bouyer, Roger Gil, Foucaud Du Boisgueheneuc
OBJECTIVE: Many neurosurgical procedures are now performed with the patient aware in order to allow interactions between the patient and healthcare professionals. These procedures include awake brain surgery and spinal cord stimulation (SCS), lead placement for treatment of refractory chronic back and leg pain. Neurosurgical procedures under local anaesthesia require optimal intraoperative cooperation of the patient and all personnel involved in surgery. In addition to accommodating this extra source of intraoperative information all other necessary sources of data relevant to the procedure must be presented...
December 2015: British Journal of Neurosurgery
Carlo Brembilla, Luigi Andrea Lanterna, Andrea Risso, Enrico Bombana, Paolo Gritti, Rosangela Trezzi, Giuseppe Bonaldi, Francesco Biroli
With the increasingly widespread illicit use of cocaine, a broad spectrum of clinical pathologies related to this form of drug abuse is emerging. The most frequently used method of administration of powdered cocaine is intranasal inhalation, or "snorting." Consequently, adverse effects of cocaine on the nasal tract are common. Habitual nasal insufflations of cocaine can cause mucosal lesions. If cocaine use becomes chronic and compulsive, progressive damage of the mucosa and perichondrium leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum...
August 2015: Journal of Neurosurgery. Spine
Paweł Sokal, Marek Harat, Piotr Zieliński, Jacek Furtak, Darek Paczkowski, Marcin Rusinek
BACKGROUND: Motor cortex stimulation is one of the neuromodulation methods of treating refractory central neurogenic pain. OBJECTIVES: The aim of this study was to retrospectively evaluate the effects of motor cortex stimulation. MATERIAL AND METHODS: The study group consisted of 14 consecutive patients with thalamic pain, atypical facial pain, post-brachial plexus avulsion injury pain, phantom pain and pain in syringomyelia who were treated with motor cortex stimulation at the Department of Neurosurgery of the Military Research Hospital in Bydgoszcz, Poland, from 2005 to 2013...
March 2015: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Ramis F Ghaly, Alexei Lissounov, Kenneth D Candido, Nebojsa Nick Knezevic
BACKGROUND: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies...
2015: Surgical Neurology International
Ralf Weigel, H Holger Capelle, Herta Flor, Joachim K Krauss
BACKGROUND: Several mechanisms were suggested in the past to explain the beneficial effect of spinal cord stimulation (SCS) in patients suffering from neuropathic pain. Little is known about potential supraspinal mechanisms. OBJECTIVE: In this study cortical signaling of patients with neuropathic pain and successful long-term treatment with SCS was analyzed. STUDY DESIGN: Observational study. SETTING: University hospital, neurosurgical department, outpatient clinic for movement disorders and pain, institute for cognitive and clinical neuroscience...
March 2015: Pain Physician
Damián Claudio Bendersky, Santiago Matias Hem, Claudio Gustavo Yampolsky
We present the results of pulsed and continuous radiofrequency (CRF) of the sphenopalatine ganglion in a case series of 3 patients with chronic cluster headache (CCH). Three patients were referred to our neurosurgical department because of CCH, which was refractory to pharmacological treatment. They underwent pulsed radiofrequency of the sphenopalatine ganglion (PRF-SPG), and the procedure was performed through an infrazygomatic approach. In the PRF procedures, we applied 2 cycles of PRF at 42°C and 45 V for 120 seconds, with a pulse frequency of 2 Hz and a pulse width of 20 ms...
June 2015: Pain Practice: the Official Journal of World Institute of Pain
Tony R Wang, Rob Dallapiazza, W Jeff Elias
Advances in transcranial MRI-guided focused ultrasound have renewed interest in lesioning procedures in functional neurosurgery with a potential role in the treatment of neurological conditions such as chronic pain, brain tumours, movement disorders and psychiatric diseases. While the use of transcranial MRI-guided focused ultrasound represents a new innovation in neurosurgery, ultrasound has been used in neurosurgery for almost 60 years. This paper reviews the major historical milestones that have led to modern transcranial focused ultrasound and discusses current and evolving applications of ultrasound in the brain...
May 2015: International Journal of Hyperthermia
Elena Virginia Colombo, Carlo Mandelli, Pietro Mortini, Giuseppe Messina, Nicola De Marco, Roberto Donati, Claudio Irace, Andrea Landi, Angelo Lavano, Massimo Mearini, Stefano Podetta, Domenico Servello, Edvin Zekaj, Carlo Valtulina, Ivano Dones
BACKGROUND: Spinal cord stimulation (SCS) is a technique used worldwide to treat several types of chronic neuropathic pain refractory to any conservative treatment. The aim of this data collection is to enforce evidence of SCS effectiveness on neuropathic chronic pain reported in the literature and to speculate on the usefulness of the trial period in determining the long-term efficacy. Moreover, the very low percentage of undesired side effects and complications reported in our case series suggests that all implants should be performed by similarly well-trained and experienced professionals...
April 2015: Acta Neurochirurgica
A Al Kaisy, D Pang, M J Desai, P Pries, R North, R S Taylor, L Mc Cracken, P Rigoard
INTRODUCTION: Failed back surgery syndrome (FBSS) results from a cascade of medical and surgical events that lead to or leave the patient with chronic back and radicular pain. This concept is extremely difficult to understand, both for the patient and for the therapist. The difficulty is related to the connotations of failure and blame directly associated with this term. The perception of the medical situation varies enormously according to the background and medical education of the clinician who manages this type of patient...
March 2015: Neuro-Chirurgie
(no author information available yet)
[This corrects the article on p. 338 in vol. 56, PMID: 25371785.].
November 2014: Journal of Korean Neurosurgical Society
Kevin J Bianchini, Luis E Aguerrevere, Brian J Guise, Jonathan S Ord, Joseph L Etherton, John E Meyers, R Denis Soignier, Kevin W Greve, Kelly L Curtis, Joy Bui
The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability...
2014: Clinical Neuropsychologist
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