scholarly journals Efficacy of Pulsed Radiofrequency or Short-Term Spinal Cord Stimulation for Acute/Subacute Zoster-Related Pain: A Randomized, Double- Blinded, Controlled Trial

2021 ◽  
pp. 215-222
Author(s):  
Tao Song
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Rating Scale ◽  
Short Form ◽  
Numeric Rating Scale ◽  
Pulsed Radiofrequency ◽  
Short Term ◽  
Time Points ◽  
Sf 36 ◽  
Double Blinded

Background: Postherpetic neuralgia (PHN) is the final stage of varicella zoster infection and a severe refractory neuropathic pain. Hence preventing transition of herpes zoster-related pain to PHN is a very important therapeutic principle for patients at an early stage, especially for older patients.Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been proven to be effective to relieve acute/subacute zoster-related pain. However, which treatment could achieve better analgesic effects remains unclear. Objectives: This study aimed to investigate the therapeutic efficacy and safety of PRF and stSCS in patients with acute/subacute zoster-related pain. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety-six patients with acute/subacute zoster-related pain were equally randomized into 2 groups: PRF group and stSCS group. Patients in the different groups were treated with high-voltage, long-duration PRF or stSCS. The therapeutic effects were evaluated using a Numeric Rating Scale (NRS-11) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dose of pregabalin (mg/d) administrated at different time points was also recorded. Results: The posttreatment NRS-11 scores in the 2 groups were significantly lower compared with baseline (P < 0.001). The NRS-11 scores in the stSCS group were significantly lower than those in the PRF group at 30 and 180 days after treatments (P < 0.05). The SF-36 scores of general health, social function, role-emotional, mental health, bodily pain, physical function, physical role, and vitality could be significantly improved at each time point after treatments in the 2 groups. Some SF-36 scores could be significantly improved at some time points in the stSCS group compared with the PRF group. The rescue drug (pregabalin) dosages were lower in the stSCS group than those in the PRF group at days 90 and 180 after treatments. There was no bleeding at the puncture site, infection, postoperative paresthesia, nerve injury, or any other serious adverse effects in either group. Limitations: Single-center study, relatively small number of patients. Conclusions: PRF and stSCS are both effective and safe therapeutic alternatives for patients with acute/subacute zoster-related pain, however, stSCS could achieve more pain relief and improvement of life quality compared with PRF. Key words: Pulsed radiofrequency, short-term spinal cord stimulation, zoster-related pain, Numeric Rating Scale, 36-Item Short Form Health Survey

Differences in calculated percentage improvement versus patient-reported percentage improvement in pain scores: a review of spinal cord stimulation trials

2021 ◽  
pp. rapm-2020-102238
Author(s):  
Jonathan M Hagedorn ◽  
Timothy R Deer ◽  
Nicholas C Canzanello ◽  
Stephen M Covington ◽  
Darrell R Schroeder ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Scale ◽  
Concordance Correlation ◽  
Percentage Improvement ◽  
Patient Reported ◽  
The Mean ◽  
Numeric Rating

IntroductionSpinal cord stimulation is frequently used for the treatment of intractable chronic pain conditions. Trialing of the spinal cord stimulator device is recommended to assess the patient’s response to neurostimulation before permanent implantation. The trial response is often assessed by Numeric Rating Scale changes and patient-reported percentage pain improvement. Using number rating scale changes between prespinal and postspinal cord stimulation trial, a calculated percentage pain improvement can be obtained. The aim of this study was to assess the difference between calculated and patient-reported percentage improvement in pain scale during spinal cord stimulation trials.MethodsThis study was a retrospective single center review of all spinal cord stimulation trials from January 1 2017 to July 1 2019. A total of 174 patients were included. The paired t-test was used to compare numeric pain scores obtained prestimulation versus poststimulation. The mean difference between methods (patient-reported minus calculated) was compared with zero using the 1-sample t-test. Lin’s concordance correlation coefficient was computed with a 95% CI, calculated using Fisher z-transformation; and a bootstrapping approach was used to compare the concordance correlation coefficient between groups. In all cases, two-tailed tests were used with p<0.05 considered statistically significant.ResultsBased on prestimulation and poststimulation numeric rating scale scores, the mean±SD calculated percentage improvement in pain scale was 54±28. The mean±SD patient-reported percentage improvement in pain scale was 59±25. The overall 95% limits of agreement for the two methods are −30% to +41%. The overall concordance correlation coefficient was 0.76 (95% CI 0.69 to 0.81).ConclusionAlthough the two methods are highly correlated, there is substantial lack of agreement between patient-reported and calculated percentage improvement in pain scale, suggesting that these measures should not be used interchangeably for spinal cord stimulator trial outcome assessment. This emphasizes the need for improved metrics to better measure patient response to neuromodulation therapies. Additionally, patient-reported percentage improvement in pain was found to be higher than calculated percentage improvement in pain, potentially highlighting the multidimensional experience of pain and the unpredictability of solely using Numeric Rating Scale scores to assess patient outcomes.

scholarly journals Different Pulsed Radiofrequency Modes on Gasserian Ganglion Improved Acute/subacute Zoster-related Trigeminal neuralgia: A Randomized, Double-Blinded, Controlled Trial

2020 ◽  
Author(s):  
Cheng-fu Wan ◽  
Tao Song
Keyword(s):  
Trigeminal Neuralgia ◽  
High Voltage ◽  
Short Form ◽  
Controlled Trial ◽  
Gasserian Ganglion ◽  
Pulsed Radiofrequency ◽  
Clinical Trial Registration ◽  
Time Points ◽  
Long Duration ◽  
Sf 36

Abstract Background: Trigeminal postherpetic neuralgia (PHN), developed from herpes zoster virus infected on gasserian ganglion, is a severe neuropathic pain and often refractory to existing treatment. Pulsed radiofrequency (PRF) is known to be effective for treating acute/subacute zoster-related pain, but the effectiveness of different PRF mode has not been tested.Objective: This study aimed to investigate the efficacy and safety of different PRF modes on gasserian ganglion in patients with acute/subacute zoster-related trigeminal neuralgia.Methods: 120 patients were equally randomized into 2 groups (n = 60): high-voltage, long-duration PRF(HL-PRF) group and standard PRF(S-PRF) group. One cycle high-voltage, long-duration PRF was applied in HL-PRF group and three cycles standard PRF were performed in S-PRF group. Visual analog scales (VAS), 36-item short form health survey scores (SF-36) and average doses of pregabalin were recorded at different time points. Results: There were significant declined in VAS and SF-36 scores in both two groups at different time point after PRF treatment (P < 0.001). The scores of VAS and SF-36 in HL-PRF group were significantly lower than those in S-PRF group at different time points after treatment (P < 0.05). The dosages of pregabalin were also lower in HL-PRF group at days 3, 14 and 28 after treatment (P < 0.05). There was no serious adverse effect in either group. Conclusion: High-voltage, long-duration PRF on gasserian ganglion is more effective than standard PRF for acute/subacute zoster-related trigeminal neuralgia patients. Clinical Trial Registration: ChiCTR2000038775

scholarly journals New Programming Modes of Spinal Cord Stimulation for Chronic Pain: A Systematic Review of Outcomes with Burst and High-Frequency Technology

2018 ◽  
Vol 07 (02) ◽  
pp. 102-115
Author(s):  
Jeffrey Bergman ◽  
Derrick Dupré ◽  
Nestor Tomycz
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Spinal Cord Stimulation ◽  
High Frequency ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Limb Pain ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Patient Pain

AbstractSpinal cord stimulation (SCS) is a well-established, evidence-based treatment for chronic pain. For decades, implantation of tonic SCS systems has relied on epidural electric lead placement to overlap regions of pain with paresthesias to achieve maximal postoperative pain relief. During the course of tonic SCS treatment, tolerances to the stimulation frequency may develop, leading to reduced efficacy. Recent developments in novel programming modes, such as high-frequency 10 kHz (HF10) and burst, stray from tonic SCS in their electrical stimulation delivery patterns and unique ability to deliver SCS without engendering paresthesias. To date, no review has analyzed outcomes of both HF10 SCS and burst SCS for chronic back and limb pain. This article aims to review all HF10 and burst SCS prospective observational and randomized controlled trials for chronic back and limb pain. The literature search identified 21 papers—10 HF10 SCS papers, 9 burst SCS papers, and 2 papers assessing both HF10 and burst SCS concurrently. Burst SCS and HF10 SCS have been subjected to randomized controlled studies and have used similar patient pain score reporting on a visual analog scale (VAS) and numeric rating scale (NRS). Results from these studies have reported significant reductions in axial back pain and limb pain in patients sustained for up 20 months with burst SCS treatment and up to 36 months with HF10 SCS. Both novel programming modes show promise as viable treatments for those suffering from chronic pain and/or patients who may no longer be responders to tonic SCS.

scholarly journals Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait—A Preliminary 3D Biomechanical Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
L. Brugliera ◽  
A. De Luca ◽  
S. Corna ◽  
M. Bertolotto ◽  
G. A. Checchia ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Rating Scale ◽  
Sagittal Plane ◽  
Short Form ◽  
Failed Back Surgery Syndrome ◽  
Clinical Scales ◽  
Flexion Extension ◽  
Failed Back Surgery ◽  
Back Surgery

We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic pain secondary to Failed Back Surgery Syndrome. The aim of our study was to investigate the effects of SCS on posture and gait by means of clinical scales (Short Form Health Survey-36, Visual Analogue Scale for pain, and Hamilton Depression Rating Scale) and instrumented evaluation with 3D Gait Analysis using a stereophotogrammetric system. The latter was performed with the SCS device turned both OFF and ON. We recorded gait and posture using the Davis protocol and also trunk movement during flexion-extension on the sagittal plane, lateral bending on the frontal plane, and rotation on the transversal plane. During and 30 minutes after the stimulation, not only the clinical scales but also spatial-temporal gait parameters and trunk movements improved significantly. Improvement was not shown under stimulation-OFF conditions. Our preliminary data suggest that SCS has the potential to improve posture and gait and to provide a window of pain-free opportunity to optimize rehabilitation interventions.

scholarly journals High-Voltage, Long-Duration Pulsed Radiofrequency on Gasserian Ganglion Improves Acute/Subacute Zoster-Related Trigeminal Neuralgia: A Randomized, Double-Blinded, Controlled Trial

2019 ◽  
Vol 4 (22;4) ◽  
pp. 361-368
Author(s):  
Tao Song
Keyword(s):  
Trigeminal Neuralgia ◽  
High Voltage ◽  
Postherpetic Neuralgia ◽  
Sham Group ◽  
Short Form ◽  
Gasserian Ganglion ◽  
Pulsed Radiofrequency ◽  
Long Duration ◽  
Sf 36 ◽  
Double Blinded

Background: Trigeminal postherpetic neuralgia is a severe neuropathic pain and often refractory to existing treatment, it develops secondary to herpes zoster-infected Gasserian ganglion. Therefore, it is important to prevent the transition of acute/subacute zoster-related pain to trigeminal postherpetic neuralgia. Despite numerous studies, the optimal intervention that reduces trigeminal postherpetic neuralgia incidence is still unknown. Objectives: This study aimed to evaluate the efficacy and safety of high-voltage, long-duration pulsed radiofrequency (PRF) on the Gasserian ganglion in patients with acute/subacute zosterrelated trigeminal neuralgia. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety-six patients with acute/subacute zoster-related trigeminal neuralgia were equally randomly assigned into 2 groups. The electrode needle punctured the Gasserian ganglion guided by computed tomography in every patient. High-voltage, long-duration PRF at 42°C for 900 seconds was applied in the PRF group (n = 48). It was also applied in the sham group (n = 48) without radiofrequency energy output. The therapeutic effects were evaluated using a visual analog scale (VAS) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dosage of pregabalin (mg/d) administrated within the first month after treatment was also recorded. Results: The postprocedure VAS scores in the PRF group were significantly lower than those in the sham group at different time points after treatment (P < 0.01). The SF-36 scores, which included physical functioning, physical role, bodily pain, general health perceptions, vitality, social function, emotional role, and the mental health index, were significantly improved at the sixth month after treatment in the PRF group compared with the sham group (P < 0.01). The average dosage of pregabalin administered (mg/d) within the first month after treatment was also significantly reduced in the PRF group compared with the sham group (P < 0.01). There were no bleeding, infection, or other severe side effects in both groups. Limitations: Single center study, relatively small number of patients. Conclusions: High-voltage, long-duration PRF on the Gasserian ganglion is an effective and safe therapeutic alternative for patients with acute/subacute zoster-related trigeminal neuralgia. Key words: Pulsed radiofrequency, zoster-related trigeminal neuralgia, visual analog scale, 36- Item Short Form Health Survey

scholarly journals Preoperative opioid strength may not affect outcomes of anterior cervical procedures: a post hoc analysis of 2 prospective, randomized trials

2015 ◽  
Vol 23 (4) ◽  
pp. 484-489 ◽  
Author(s):  
Michael P. Kelly ◽  
Paul A. Anderson ◽  
Rick C. Sasso ◽  
K. Daniel Riew
Keyword(s):  
Rating Scale ◽  
Short Form ◽  
Neck Disability Index ◽  
Numeric Rating Scale ◽  
Success Rates ◽  
Opioid Use ◽  
Arm Pain ◽  
Sf 36 ◽  
Scale Scores ◽  
Cervical Disease

OBJECT The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. METHODS A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-Item Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively. RESULTS Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker’s Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong −52.3, weak −50.6, naïve −54.0, p = 0.244; neck: strong −52.7, weak −50.8, naïve −44.6, p = 0.355); NDI scores (strong −36.0, weak −33.3, naïve −32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point. CONCLUSIONS Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient population.

Auricular vagal nerve stimulation in peripheral arterial disease patients

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 462-470 ◽  
Author(s):  
Gerald Hackl ◽  
Andreas Prenner ◽  
Philipp Jud ◽  
Franz Hafner ◽  
Peter Rief ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Nerve Stimulation ◽  
Short Form ◽  
Therapeutic Option ◽  
Arterial Disease ◽  
Walking Distance ◽  
Control Group ◽  
Sf 36 ◽  
Peripheral Arterial ◽  
Double Blinded

Abstract. Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established. Patients and methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defined as a significantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a significant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36). Results: There were no differences in baseline characteristics between the two groups. The initial walking distance significantly increased in both groups (verum group [means]: 182 [95 % CI 128–236] meters to 345 [95 % CI 227–463] meters [+ 90 %], p < 0.01; control group [means]: 159 [95 % CI 109–210] meters to 268 [95 % CI 182–366] meters [+ 69 %], p = 0.01). Twelve patients (60 %) in the verum group and five patients (25 %) in controls reached the primary endpoint of doubling walking distance (p = 0.05). The total score of WIQ significantly improved in the verum group (+ 22 %, p = 0.01) but not in controls (+ 8 %, p = 0.56). SF-36 showed significantly improvements in six out of eight categories in the verum group and only in one of eight in controls. Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.

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