title: [Neuromodulation in severe neuropathic pain].
abstract: Pain relief in patients with chronic neuropathic pain can be difficult to accomplish. If pharmacological treatment combined with a form of physical therapy and psychological support does not lead to improvement, nerve blocks and rehabilitation can be considered. Appropriately screened patients with persistent incapacitating pain may respond to neuromodulation. A specific form of this technique - spinal cord stimulation - delivers electric pulses via an implanted electrode connected to a battery in the epidural space around the spinal cord. We describe three patients, two of whom had persistent leg pain after disc surgery. The third patient suffered from diabetic neuropathy. Despite thorough pre-procedural screening by an anaesthetist-pain specialist, psychologist, physical therapist and specialised nurse, spinal cord stimulation failed in one patient. Psycho-social factors, inadequate coping skills and depression may lead to inadequate improvement and failure of this therapy.
authors.affiliation: Radboudumc, afd. Anesthesiologie, Pijn en Palliatieve Geneeskunde, Nijmegen.
authors.forename: Robert T M
authors.initials: RT
authors.lastname: van Dongen
authors.forename: Han
authors.initials: H
authors.lastname: Samwel
authors.forename: Inge J J
authors.initials: IJ
authors.lastname: Arnts
authors.forename: Monique A H
authors.initials: MA
authors.lastname: Steegers
authors.forename: Elbert A
authors.initials: EA
authors.lastname: Joosten
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
mesh_terms: D000328:Adult; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009437:Neuralgia / Q000628:therapy*; D059408:Pain Management / Q000295:instrumentation / Q000379:methods; D013116:Spinal Cord; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*