by Phillip Kim. MD
Neurostimulation is the application of precise targeted electrical stimulation on nociceptive pathways. Electric stimulation has a long history in medicine for treating various ailments. Beyond the application of electrodes on the skin such as in transcutaneous electrical nerve stimulation (TENS), electrodes have been applied directly to nociceptive pathways.
The nociceptive pathways are made up of tracts in the central and peripheral nervous systems. The central nervous system includes nociceptive pathways in the spinal cord and brain, specifically the dorsal roots, dorsal ganglion, spinothalamic tracts, and all ascending neural tracts to the cerebrum. The peripheral nervous system includes pathways outside the spinal cord, specifically various plexuses and peripheral nerves.
Spinal cord stimulation involves the placement of an electrical system to block nociception. The system comprises the surgical placement of epidural electrodes, cables, and radiofrequency transmitter or battery. Much of this method has evolved from cardiac pacemaker technology. The minimal invasiveness and trialing has led to the success of this approach. Neurostimulation can be placed during an outpatient procedure, with local anesthesia and sedation. The patient experiences minimal discomfort when the system is placed and during the postoperative period.
continue reading on Medscape.com
http://www.medscape.com/viewarticle/473431
Boston Scientific Announces new rechargeable SCS neuromodulation device for the treatment of chronic pain of the trunk, back and limbs. Precision Plus provides physicians with EGL Scan and also features an improved remote control and charger. The charger is approximately 75 percent smaller and 85 percent lighter than competing chargers and continuous temperature monitoring.
EGL Scan (Electronically Generated Lead Scan) technology displays the relative position of implanted leads, within seconds and without using fluoroscopy or x-ray. The information from EGL Scan can be used to increase programming accuracy, which can lead to improvements in patient outcomes and treatment office operating efficiencies.
Company Information:
Name: Boston Scientific Corp.
Address: 1 Prime Pkwy.
City: Natick
State: MA
ZIP: 01760
Country: USA
Phone: 508-650-8000
http://www.bostonscientific.com
Sympathetic therapy describes a type of electrical stimulation of the peripheral nerves that is designed to stimulate the sympathetic nervous system in an effort to “normalize” the autonomic nervous system and alleviate chronic pain. Unlike TENS (transcutaneous electrical nerve stimulation) or interferential electrical stimulation, sympathetic therapy is not designed to treat local pain, but is designed to induce a systemic effect on sympathetically induced pain.
Sympathetic therapy uses 4 intersecting channels of various frequencies with bilateral electrode placement on the feet, legs, arms, and hands. Based on the location of the patient’s pain and treatment protocols supplied by the manufacturer, electrodes are placed in various locations on the lower legs and feet or the hands and arms. Electrical current is then induced with beat frequencies between 0 and 1000 Hz. Treatment may include daily 1-hour treatments in the physician’s office, followed by home treatments if the initial treatment is effective.
The Dynatron STS device and a companion home device, Dynatron STS Rx, are devices that deliver sympathetic therapy. These devices received U.S. Food and Drug Administration (FDA) clearance in March 2001 through a 510(k) process. The FDA-labeled indication is as follows:
“Electrical stimulation delivered by the Dynatron STS and Dynatron STS Rx is indicated for providing symptomatic relief of chronic intractable pain and/or management of post-traumatic or post-surgical pain.”
Sympathetic therapy is considered investigational.
Ideally, assessment of therapies designed to treat chronic pain should be based on placebo controlled trials to assess the magnitude of the expected placebo effect and to isolate the contribution of the active treatment. Outcomes of interest might include changes in scores of a visual analog scale, quality of life measures such as an SF-36, reduction in pain medications, daily activity levels, or return to work. However, a MEDLINE search did not identify any studies published in the peer-reviewed literature regarding sympathetic therapy. An information packet from the manufacturer Dynatron (Salt Lake City, UT) (2) includes two articles also referenced in their promotional material. Although these 2 articles have not been published in the peer-reviewed literature, they are briefly reviewed below.
Steven Sacks and colleagues reported on a retrospective study of 197 patients with chronic pain of various origins including upper and lower extremity pain and migraine. Some patients reported multiple sites of pain, and each different site of pain was registered as a separate pain complaint, resulting in 227 patient records. Of these, 91% reported mild pain relief with 33% reporting complete pain relief. A total of 78% reported an increase in their daily living activities by 50% or more, and 69% reported a decrease in medications. No data were reported regarding the various etiologies of pain, prior treatment including baseline drug requirements, exact treatment protocol, the number of treatments, or how pain relief, activities of daily living, or other treatment outcomes were evaluated. There was no control group.
Guido reported on the effects of sympathetic therapy in 20 volunteers suffering from chronic pain related to peripheral neuropathy. The treatment protocol varied with the site of pain, i.e., upper versus lower extremity and could vary from day to day. Patients underwent daily therapy for 28 days. At the end of the study, the mean global Visual Analog Scale scores were significantly reduced, although these data are not presented in a table or figure. There was no control group.