Long-Term Reduction of Sacroiliac Joint Pain With Peripheral Nerve Stimulation.

BACKGROUND: We recently demonstrated that 86% of the patients treated with peripheral nerve stimulation (PNS) for therapy-refractory sacroiliac joint (SIJ) pain were satisfied with the result after 1 year of treatment. OBJECTIVE: To investigate the long-term (up to 4 years) response rate of this novel treatment. METHODS: Sixteen consecutive patients with therapy-refractory SIJ pain were treated with PNS and followed for 4 years in 3 patients, 3 years in 6 patients, and 2 years in 1 patient. Quality of life, pain, and patient satisfaction were assessed using the Oswestry Disability Index 2.0, Visual Analog Scale (VAS), and International Patient Satisfaction Index. RESULTS: Patients reported a pain reduction from 8.8 to 1.6 (VAS) at 1 year ( P < .001), and 13 of 14 patients (92.9%) rated the therapy as effective (International Patient Satisfaction Index score ≤ 2). At 2 years, average pain score was 1.9 ( P < .001), and 9 of 10 patients (90.0%) considered the treatment a success. At 3 years, 8 of 9 patients (88.9%) were satisfied with the treatment results, reporting an average VAS of 2.0 ( P < .005). At 4 years, 2 of 3 patients were satisfied with the treatment results. CONCLUSION: We have shown for the first time that PNS is a successful long-term therapy for SIJ pain.

Technical Note: Treatment of Sacroiliac Joint Pain with Peripheral Nerve Stimulation.

INTRODUCTION: Sacroiliac joint (SIJ) pain affects older adults with a prevalence of up to 20% among patients with chronic low back pain. While pain medication, joint blocks and denervation procedures achieve pain relief in most patients, some cases fail to improve. Our goal was to determine the effectiveness of SIJ peripheral nerve stimulation in patients with severe conservative therapy-refractory SIJ pain. MATERIALS AND METHODS: Here we present 12 patients with severe conservative therapy-refractory pain receiving an SIJ peripheral nerve stimulation. Patient satisfaction, pain, and quality of life were evaluated by means of the International Patient Satisfaction Index (IPSI), visual analog scale (VAS), and Oswestry Disability Index 2.0 (ODI) using standard questionnaires. For stimulation we placed an eight-pole peripheral nerve electrode parallel to the SIJ. RESULTS: Two weeks postoperatively, our patients reported an average ODI reduction from 57% to 32% and VAS from 9 to 2.1. IPSI was 1.1. After six months, the therapy was rated as effective in seven out of eight patients reporting at that period. The average ODI was low at 34% (p = 0.0006), while the VAS index rose to 3.8 (p < 0.0001) and IPSI to 1.9. Twelve months after stimulation, six out of seven patients considered their treatment a success with an average ODI of 21% (p < 0.0005), VAS 1.7 (p < 0.0001), and IPSI 1.3. CONCLUSIONS: We conclude that SIJ stimulation is a promising therapeutic strategy in the treatment of intractable SIJ pain. Further studies are required to determine the precise target group and long-term effect of this novel treatment method.

Proton-coupled high-affinity phosphate transport revealed from heterologous characterization in Xenopus of barley-root plasma membrane transporter, HvPHT1;1.

High-affinity phosphate transporters mediate uptake of inorganic phosphate (P(i) ) from soil solution under low P(i) conditions. The electrophysiological properties of any plant high-affinity P(i) transporter have not been described yet. Here, we report the detailed characterization of electrophysiological properties of the barley P(i) transporter, HvPHT1;1 in Xenopus laevis oocytes. A very low K(m) value (1.9 µm) for phosphate transport was observed in HvPHT1;1, which falls within the concentration range observed for barley roots. Inward currents at negative membrane potentials were identified as nH+ :P(i)⁻ (n > 1) co-transport based on simultaneous P(i) radiotracer uptake, oocyte voltage clamping and pH dependence. HvPHT1;1 showed preferential selectivity for P(i) and arsenate, but no transport of the other oxyanions SO4²â» and NO3⁻. In addition, HvPHT1;1 locates to the plasma membrane when expressed in onion (Allium cepa L.) epidermal cells, and is highly expressed in root segments with dense hairs. The electrophysiological properties, plasma membrane localization and cell-specific expression pattern of HvPHT1;1 support its role in the uptake of P(i) under low P(i) conditions.