[Show abstract][Hide abstract] ABSTRACT: The goal of this study was to evaluate the long-term efficacy and safety of peripheral nerve field stimulation (PNFS) for chronic low back pain (cLBP).
In this prospective, multicenter observational study, 118 patients were admitted to 11 centers throughout Austria and Switzerland. After a screening visit, all patients underwent a trial stimulation period of at least seven days before implantation of the permanent system. Leads were placed in the subcutaneous tissues of the lower back directly in the region of greatest pain. One hundred five patients were implanted with a permanent stimulating system. Patients' evaluation of pain and functional levels were completed before implantation and one, three, and six months after implantation. Adverse events, medication usage, and coverage of the painful area and predictive value of transcutaneous electrical nerve stimulation (TENS) were monitored.
All pain and quality-of-life measures showed statistically significant improvement during the treatment period. These included the average pain visual analog scale, the Oswestry Disability Questionnaire, the Becks Depression Inventory, and the Short Form-12 item Health survey. Additionally, medication usage with opioids, nonsteroidal anti-inflammatory drugs, and anti-convulsants showed a highly significant reduction. Complications requiring surgical intervention were reported in 9.6% of the patients. The degree of coverage of painful areas seems to be an important criterion for efficacy of PNFS, whereas TENS is presumably no predictor.
This prospective, multicenter study confirms that PNFS is an effective therapy for the management of cLBP. Significant improvements in many aspects of the pain condition were measured, and complications were minimal.
[Show abstract][Hide abstract] ABSTRACT: Background and aims
Peripheral neuropathic pain (PNeP) is a chronic and disabling condition for which no predictors of response to treatment have yet been identified. Clinical studies show that while many patients with PNeP respond positively to treatment with the capsaicin 8% patch, others do not. This study used quantitative sensory testing (QST) to determine whether any patient characteristics can predict response to treatment with the capsaicin 8% patch.
This was a prospective, non-placebo-controlled, observational study. Patients used the Visual Analogue Scale (VAS) to assess their pain at baseline and then on Days 1, 7–10 (from here referred to as Day 7/10), 28 and 84 following treatment with the capsaicin 8% patch. QST was undertaken at the same timepoints on the painful area at the region of maximum PNeP and on a contralateral, control area. In addition, the size of the painful area was assessed at baseline and Days 7/10, 28 and 84.
A total of 57 patients were treated. Among 54 evaluable patients, 19 (35.2%) achieved a ≥30% reduction in VAS pain score at Day 7/10 post-treatment compared with baseline — these were defined as ‘responders’. Analysis of the QST data showed that the PNeP area in responders, but not in non-responders, had a significantly lower pressure pain threshold compared with the control area at baseline (median 320 kPa vs. 480 kPa, respectively; p = .004). Furthermore, non-responders had approximately three times greater degree of allodynia at baseline compared with responders across tests using brush, cotton wool and Q-tip. These differences were significant for tests using brush and cotton wool (p = .024 and p = .046, respectively) and approached significance in the test using Q-tip (p = .066). Following treatment with the capsaicin 8% patch, responders showed a trend towards a reduction in warm perception and also appeared to show normalization of the pinprick hyperalgesia at some stimulus levels. Responders to therapy had significantly greater reductions than non-responders in the size of the painful area at Day 28 (p = .011) and Day 84 (p = .005) following treatment. However, both responders and non-responders had meaningful reductions in the size of the painful area compared with baseline values.
This study suggests that differences can be identified in the sensory profiles of patients with PNeP who respond to the capsaicin 8% patch and those who do not, specifically pressure pain threshold and degree of allodynia. Notably, both responders and non-responders experienced meaningful reductions in the size of the painful area following treatment.
The findings warrant further investigation in a larger number of patients and in prospective trials.
Scandinavian Journal of Pain. 07/2013; 4(3):138-145.
[Show abstract][Hide abstract] ABSTRACT: Topical 8 % capsaicin is an established therapeutic option for the treatment of peripheral neuropathic pain. In accordance with the internationally accepted definition, complex regional pain syndrome (CRPS) type II is a form of neuropathic pain so that capsaicin plasters represent a treatment option. However, for the treatment of CRPS it is recommended that painful stimuli should be avoided but capsaicin induces a strong nociceptive stimulation and so its use is at present controversial.We report on the course of such an application in a patient who developed CRPS type II with intractable neuropathic pain after hallux surgery. As a result of a single treatment with capsaicin a pronounced recurrence developed with central nervous symptoms.
[Show abstract][Hide abstract] ABSTRACT: Stimulation of primary afferent neurons offers a new approach for the control of localized chronic pain. We describe the results with a new neurostimulation technique, subcutaneous target stimulation (STS), for the treatment of chronic focal noncancer pain. STS applies permanent electrical stimulation directly at the painful area via a percutaneous-placed subcutaneous lead. We reported the clinical outcomes of 111 patients with focal chronic, noncancer pain treated with STS in this first nationwide, multicenter retrospective analysis. The indications for STS were low back pain (n = 29) and failed back surgery syndrome (back pain with leg pain) (n = 37), cervical neck pain (n = 15), and postherpetic neuralgia (n = 12). Pain intensity was measured on a numerical rating scale (NRS) before and after implantation. Data on analgesic medication, stimulation systems, position, and type of leads and complications were obtained from the patients' records. After implantation, the mean pain intensity improved by more than 50% (mean NRS reduction from 8.2 to 4.0) in the entire patient group (P = 0.0009). This was accompanied by a sustained reduction in demand for analgesics. In all the patients, the STS leads were positioned directly at the site of maximum pain. Lead dislocation occurred in 14 patients (13%), infections in 7 (6%), and in 6 cases (5%), lead fractures were observed. The retrospective data analysis revealed that STS effectively provided pain relief in patients suffering from refractory focal chronic noncancer pain and that STS is an alternative treatment option. Prospective controlled studies are required to confirm these retrospective findings. This article presents a new minimally invasive technique for therapy-resistant focal pain.
Pain Practice 03/2010; 10(4):279-86. · 2.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die intrathekale Schmerztherapie in Form implantierter Pumpen ist eine wirksame und sichere Therapieoption fr ausgewhlte Patienten mit schweren chronischen Schmerzen. Sie hat aufgrund der hohen Effektivitt bei geringen Nebenwirkungen und deutlichen Verbesserung der Lebensqualitt dann Vorzge gegenber der systemischen Langzeitopiattherapie, wenn die blichen Schmerztherapien ausgeschpft sind und ein kausaler Eingriff keine Besserung verspricht. Damit ist sie im Kanon der schmerztherapeutischen Behandlungsoptionen bei malignen und benignen chronischen Schmerzen und bestimmten Formen der Spastizitt etabliert. Sorgfltige Patientenselektion und optimales Patientenmanagement sowie ein multidisziplinres Vorgehen sind u.a. Determinanten fr einen Therapieerfolg. Dieser Beitrag gibt eine bersicht ber Indikationen und Auswahlkriterien, Testverfahren, Substanzauswahl, Dosierungsempfehlungen, Aspekte der Implantation und Nachsorge.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.
Der Schmerz 01/2007; 21(1):15-27. · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
Der Schmerz 12/2006; 21(1):15-8, 20-4, 26-7. · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Topisches Capsaicin 8% ist zur Behandlung peripherer neuropathischer Schmerzen etabliert. Bei einem komplexen regionalen Schmerzsyndrom (CRPS) Typ II handelt es sich nach internationaler Definition um einen neuropathischen Schmerz, sodass das Capsaicinpflaster einerseits eine Therapieoption darstellt. Andererseits spricht jedoch das anerkannte Konzept, bei der Behandlung des CRPS Schmerzreize zu vermeiden, gegen den Einsatz von Capsaicin.
Wir berichten über den Verlauf einer solchen Anwendung bei einer Patientin, die nach einer Halluxoperation an einem CRPS Typ II mit therapieresistenten neuropathischen Schmerzen litt. In Folge einer einmaligen Behandlung mit Capsaicin entwickelte sich ein ausgeprägtes Rezidiv mit zentralnervösen Symptomen.