So, it's important to slow the process as much as possible."ĭPN can be a paradoxically two-pronged problem, first manifesting as an inability to correctly discern textures, often leading to lack of sensation in distal extremities that can prevent the patient from detecting dangerous external stimuli. "It's a progressive process that can cause extensive pain in the extremities, especially the fingers and toes, and can lead to more dangerous complications. Mayfield neurosurgeons surgically implant more than 250 spinal cord stimulators each year for a wide range of conditions, including chronic back pain, amputated stump pain, and complex regional pain syndrome.Ī 2015 study, published by Cleveland researchers in Neuromodulation: Technology at the Neural Interface, found that of 234 patients who underwent implantation of spinal cord stimulation devices from 2007 to 2013, 56 patients had their devices removed (23.9 percent) over the next eight years."DPN is a debilitating complication of Type 1 and Type 2 diabetes," said Nauni Virdi, M.D., regional medical director, US and Canada, Abbott Diabetes Care. This is a population for whom it's just not working as effectively." They're more likely to feel their spinal cord stimulator is not working properly and have it removed. "People with a dysfunctional coping profile are likely not receiving as much benefit. "Patients who have these comorbid psychiatric issues tend to not have as efficacious an experience with the spinal cord stimulator," Dr. Gozal said that patients with pain in general have a higher presence of psychiatric disorders and that more research is needed to understand the role that psychiatric issues play in an individual's perception and accommodation of pain. It's not clear, however, whether pain was causing these patients to have higher levels of depression."ĭr. "If you consider the patients who had formal psychiatric evaluations and look at their rates of comorbid psychiatric diseases, 64 percent had major depression and 35 percent had anxiety. "Patients with depression and anxiety were more likely to undergo removal of the device within a year of treatment than after a year of treatment," Dr. For most patients in the study, however, the system was removed after a longer period of time because of ineffectiveness, loss of stimulation, infection, or the migration of the stimulator electrodes that were placed over the spinal cord. The 15 patients who had their stimulators removed quickly, in a median time of 2 months, typically suffered an acute post-surgical complication, such as infection. Half of the patients were legally disabled, and the most common cause of their chronic pain was flat back syndrome, a complication that can occur following multiple spine surgeries. Pre-implantation trials to determine efficacy were performed on all patients treated at Mayfield. Of the 129 patients in the study, 72 had their devices implanted by Mayfield surgeons, and 57 had their devices implanted by other practitioners. The researchers also noted that a large subset of patients who experienced spinal cord stimulator failure also experienced high rates of major depression, anxiety, physical or sexual abuse, post- traumatic stress disorder, or drug and/or alcohol abuse.īy performing the study, the physicians aimed "to shed light on potential avenues to reduce morbidity and improve patient outcomes." Led by Mayfield neurosurgeons George Mandybur, MD, and Yair Gozal, MD, PhD, the retrospective study found that stimulator systems were removed because of certain surgical or device-associated complications, such as an infection, or because the system no longer provided relief. Researchers from Mayfield Brain & Spine explored the reasons why spinal cord stimulator systems were removed in 129 patients over a period of 9 years (2005-2013) and published their findings in the Journal of Neurosurgery: Spine. Although spinal cord stimulation is a well-established treatment that has helped thousands of patients with chronic pain syndromes, it is not effective in all cases.
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