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Objectives The objective of this study was to present results from a multicenter registry designed to obtain longitudinal clinical outcome data for patients implanted with a neuromodulation system for the management of chronic pain of the trunk and/or limbs. Materials and Methods Interim data from 579 patients across 40 study sites were analyzed from a prospective, observational, noninterventional registry. Institutional review board approval was obtained prior to enrollment. The following were recorded at baseline and at 3, 6, and 12 months postimplant: patient-reported pain relief, categorical ratings of pain relief, Pain Disability Index (PDI) scores, quality of life, medication usage, and patient satisfaction. Pain relief among (tobacco) smokers was also assessed. Descriptive statistics were compiled for all patient outcome measurements, and data are reported as mean (±standard deviation). All statistical analysis was conducted using one-sided t-tests with a significance level of α = 0.05. Device-related adverse events were captured and are reported. Results Patient-reported pain relief was 58.0% (±26.2%) at 3 months, 58.1% (±28.7%) at 6 months, and 57.0% (±29.4%) at 12 months. Mean PDI scores were reduced from 47.7 points at baseline to 33.3, 32.4, and 31.9 points, respectively (p ≤ 0.001). The majority of patients categorized their pain relief as “excellent” or “good” and reported their overall quality of life as “greatly improved” or “improved” at all time points. In addition, greater than 79% of patients were “satisfied” or “very satisfied” with the therapy at all time points assessed, and 47.1% of patients “stopped” or “decreased” use of narcotics/opioids. Pain relief was significantly attenuated by smoking (p = 0.042). The most common adverse event was persistent pain and/or numbness at implantable pulse generator/lead site, which accounted for 18.6% of all events in 3.2% of all patients. Conclusions These results provide evidence to further support the safety, efficacy, and sustainability of neuromodulation in clinical practice.

Objective This longitudinal, clinical outcome study was a multicenter, prospective, observational, registry with a 24-month assessment of patients implanted with spinal cord stimulation (SCS) systems for the management of chronic pain of the trunk and/or limbs. Methods On informed consent and institutional review board approval, 614 patients from 39 sites were enrolled within 30 days following permanent SCS system implantation. Medication usage, patient-reported pain relief (PRP), categorical ratings of pain relief, pain disability index scores (PDI), quality of life (QoL), and patient satisfaction were assessed at enrollment, 3-, 6-, 12-, 18-, and 24-month postimplant. Device-related adverse events (AEs) were recorded and reported. Results Across all visits, statistically significant improvements were reported on all outcome measures. Mean PRP was 58.5% (± 26.4) at 3 months, 56.8% (± 29.2) at 6 months, 57.7% (± 28.9) at 12 months, 55.6% (± 29.8) at 18 months, and 56.3% (± 30.3) at 24 months. More than 65% of patients at any visit reported a PRP ≥ 50%. Mean PDI scores reduced from 46.9 points at baseline to 32.7, 31.8, 31.5, 32.1, 32.1 points at 3, 6, 12, 18, and 24 months (p ≤ 0.0001), respectively. Greater than 76% of patients at any visit were satisfied with their therapy. The majority of patients categorized pain relief as excellent or good on a 5-item scale and reported overall QoL as greatly improved or improved on a 5-item scale. An average of 88% of patients stopped, decreased, or did not change dose of narcotics/opioids. The most common AE was diminished or loss of pain relief in 11.4% of enrolled patients. Conclusions Most patients experienced substantial pain relief and a significant improvement in all outcome measures. These results further support the safety, efficacy, and sustainability of SCS in clinical practice.

Objective: A patient with postherpetic neuralgia (PHN) did not respond to medications, either singly or in combination, or to intrathecal methylprednisolone but responded to intrathecal alcohol. This evidenced-based case management article evaluates and grades the evidence for the prevention and treatment of PHN. Methods: A search of published English-language studies on the prevention and treatment of PHN was made. Results: Randomized clinical studies showed the efficacy of antiviral agents in the prevention of PHN and the use of anticonvulsants, antidepressants, opioids, and Lidoderm patch in the treatment of PHN (level A evidence). The role of epidural local anesthetic and steroid injections in preventing PHN has not been completely established (level B evidence). Intrathecal steroid injections and topical capsaicin may be effective in PHN (level B evidence). No randomized controlled study supports the usefulness of spinal cord stimulation and intrathecal alcohol. Conclusions: Postherpetic neuralgia should be managed pharmacologically. If not effective, intrathecal steroid injections or nerve blocks may be tried. Spinal cord stimulation or intrathecal alcohol should be used only as a last resort.