RESUMO
Studies have shown that spinal cord stimulation (SCS) can reduce chronic pain by at least 50% over prolonged periods, improve function and quality-of-life, reduce requirements for healthcare resources and enable return to work in appropriately selected patients. However, SCS does not provide pain relief in all patients and is an expensive, labor intensive and invasive procedure with complications and ongoing management that requires specialists with specific skills and judgment. Multidisciplinary selection of appropriate patients for SCS is essential to achieve maximal benefit from the procedure. The aim of the article is to provide a clinical practice guide to the likely effectiveness of SCS in treating various types of chronic pain, as supported by the literature. The article will summarize indications and contraindications for SCS, provide guidance on the selection and timing for referral, and highlight the benefits and complications associated with the procedure.
Assuntos
Dor Crônica/terapia , Terapia por Estimulação Elétrica/normas , Guias como Assunto/normas , Seleção de Pacientes , Medula Espinal , Animais , Dor Crônica/diagnóstico , Eletrodos Implantados/normas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Medula Espinal/patologiaRESUMO
OBJECTIVE: To evaluate the outcome and complications of spinal cord stimulation (SCS) for chronic neuropathic pain in an Australian population. MATERIALS AND METHODS: An independent researcher retrospectively examined the records of 138 patients trialing SCS between 1995 and 2002 at our institution. Information collected included pain relief, ability to perform activities of daily living (ADLs), return to work and reduction in opiate analgesia. Clinical, psychological, demographic and financial data were also collected. RESULTS: Of 138 patients who trialed SCS, 103 (74.7%) achieved a greater than 50% reduction in their pain and proceeded to permanent implantation. At 1 year following permanent implantation, 84.4% of these still had a reduction in their pain by greater than 50%. The majority of patients, 59.1%, stated that their analgesia was good (50-74% pain reduction). All patients required opiate analgesics prior to SCS implantation, but this fell to 54.6% after SCS implantation. Additionally, 73.6% had a significant improvement in their ability to perform ADLs and 24% of patients were able to return to work. CONCLUSION: SCS is an effective treatment in the control of chronic neuropathic pain, particularly in combination with comprehensive medical management within a multidisciplinary pain management centre.
Assuntos
Terapia por Estimulação Elétrica , Dor Intratável/terapia , Doenças do Sistema Nervoso Periférico/terapia , Medula Espinal/fisiologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Eletrodos Implantados , Emprego , Feminino , Humanos , Seguro , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Intratável/etiologia , Dor Intratável/psicologia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/psicologia , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Estudos Retrospectivos , Caracteres Sexuais , Resultado do TratamentoRESUMO
The present case report describes the observed sequelae following an inadvertent intrathecal injection of tramadol in a patient with metastatic malignancy. The contributing circumstances before the injection are discussed, as is the potential aetiology of the observed sequelae.