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      Disertación sobre la estimulación cordonal posterior para el tratamiento del dolor: revisión no sistemática de la literatura Translated title: Dissertation on Spinal Cord Stimulation for Pain Management. Non-Systematic Review of the Literature

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          Abstract

          Resumen El dolor es uno de los síntomas (dolor agudo) y patologías (dolor crónico) que afectan más desde todo punto de vista a la población general y a la sociedad. Desde cualquier aspecto analizado, los gastos emocionales y monetarios son inmensos. Cuando el dolor se convierte en crónico, requiere tratamientos excepcionales que permitan un control adecuado de los síntomas. Entre los procedimientos utilizados para el control del dolor crónico en neurocirugía se encuentra la estimulación eléctrica continua de los cordones posteriores de la médula en el segmento en el cual se origina la sintomatología. Es un procedimiento estandarizado que se usa desde mitad de los años setenta y que ha demostrado una gran utilidad. En este artículo se busca presentar una narrativa a partir de una revisión no sistemática de la literatura, donde se ilustra el desarrollo histórico del concepto y los parámetros básicos para su realización.

          Translated abstract

          Abstract Pain is one of the symptoms (acute pain) and pathologies (chronic pain) that affect the general population and society the most from every point of view. From any aspect analyzed, the emotional and monetary expenses are immense. When pain becomes chronic, it requires exceptional treatments that allow adequate control of symptoms. Among the procedures used for the control of chronic pain in neurosurgery is the spinal cord estimulation in the segment in which the symptoms originate. It is a standardized procedure that has been used since the mid-1970s and has shown great utility. In this article we seek to present a narrative made from a non-systematic review of the literature, where we illustrate the historical development of the concept and the basic parameters for its realization.

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          Most cited references72

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          Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment.

          Neuropathic pain develops as a result of lesions or disease affecting the somatosensory nervous system either in the periphery or centrally. Examples of neuropathic pain include painful polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and post-stroke pain. Clinically, neuropathic pain is characterised by spontaneous ongoing or shooting pain and evoked amplified pain responses after noxious or non-noxious stimuli. Methods such as questionnaires for screening and assessment focus on the presence and quality of neuropathic pain. Basic research is enabling the identification of different pathophysiological mechanisms, and clinical assessment of symptoms and signs can help to determine which mechanisms are involved in specific neuropathic pain disorders. Management of neuropathic pain requires an interdisciplinary approach, centred around pharmacological treatment. A better understanding of neuropathic pain and, in particular, of the translation of pathophysiological mechanisms into sensory signs will lead to a more effective and specific mechanism-based treatment approach. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Chronic back pain is associated with decreased prefrontal and thalamic gray matter density.

            The role of the brain in chronic pain conditions remains speculative. We compared brain morphology of 26 chronic back pain (CBP) patients to matched control subjects, using magnetic resonance imaging brain scan data and automated analysis techniques. CBP patients were divided into neuropathic, exhibiting pain because of sciatic nerve damage, and non-neuropathic groups. Pain-related characteristics were correlated to morphometric measures. Neocortical gray matter volume was compared after skull normalization. Patients with CBP showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain. Regional gray matter density in 17 CBP patients was compared with matched controls using voxel-based morphometry and nonparametric statistics. Gray matter density was reduced in bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct for neuropathic and non-neuropathic CBP. Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.
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              Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome.

              Patients with neuropathic pain secondary to failed back surgery syndrome (FBSS) typically experience persistent pain, disability, and reduced quality of life. We hypothesised that spinal cord stimulation (SCS) is an effective therapy in addition to conventional medical management (CMM) in this patient population. We randomised 100 FBSS patients with predominant leg pain of neuropathic radicular origin to receive spinal cord stimulation plus conventional medical management (SCS group) or conventional medical management alone (CMM group) for at least 6 months. The primary outcome was the proportion of patients achieving 50% or more pain relief in the legs. Secondary outcomes were improvement in back and leg pain, health-related quality of life, functional capacity, use of pain medication and non-drug pain treatment, level of patient satisfaction, and incidence of complications and adverse effects. Crossover after the 6-months visit was permitted, and all patients were followed up to 1 year. In the intention-to-treat analysis at 6 months, 24 SCS patients (48%) and 4 CMM patients (9%) (p<0.001) achieved the primary outcome. Compared with the CMM group, the SCS group experienced improved leg and back pain relief, quality of life, and functional capacity, as well as greater treatment satisfaction (p

                Author and article information

                Journal
                unmed
                Universitas Medica
                Univ. Med.
                Pontificia Universidad Javeriana (Bogotá, Distrito Capital, Colombia )
                0041-9095
                2011-0839
                June 2021
                : 62
                : 2
                : e32430
                Affiliations
                [1] Bogotá orgnamePontificia Universidad Javeriana orgdiv1Facultad de Medicina Colombia juan.acevedo@ 123456javeriana.edu.co
                Article
                S2011-08392021000200017 S2011-0839(21)06200200017
                10.11144/javeriana.umed62-2.decp
                6dd77435-83fb-4a9c-9fba-9244c5d830b1

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 15 March 2021
                : 27 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 72, Pages: 0
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                SciELO Colombia

                Self URI: Texto completo solamente en formato PDF (ES)
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                Revisión

                columna,review,neuromodulation,spine,spinal cord stimulation,pain,neuromodulación,revision,estimulación medular,dolor

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