![]() Lastly, we describe new therapeutic targets and approaches that show promise of providing durable relief. ![]() We then proceed to discuss the use of existing SCS systems and programming strategies for the treatment of chronic visceral pain. We specifically exclude applications of SCS for angina, as this has been investigated thoroughly by others, beginning with early work by Börjesson and Norssell and later by Taylor and colleagues. Therefore, our first goal is to provide an updated overview of the topic, emphasizing neuromodulation for some of the more difficult-to-treat conditions such as chronic pelvic pain in males and females. Subdivisions of this classification have been established according to mechanism and location of pain. Three main mechanisms are listed as causes of chronic secondary visceral pain: persistent inflammation, vascular mechanisms, and mechanical factors. If visceral etiology of the pain is highly probable, originating from internal organs of the head or neck region or of the thoracic, abdominal, or pelvic cavity, the pain is classified as chronic secondary visceral pain. According to this new classification, chronic primary visceral pain is pain with a duration greater than three months (among other conditions under the chronic primary pain code) that originates within internal organs for which no underlying causes can be identified. The goal of this task force was to generate better epidemiological data to improve treatment guidelines by aggregating disease-specific treatments, generic analgesic treatments, and potentially novel treatments directed toward specific mechanisms of pain. Recently, in support of the 11th revision of the International Classification of Diseases (ICD-11), a working group from the International Association for the Study of Pain (IASP) established a task force, along with members of the World Health Organization (WHO), for the purpose of developing a systematic classification of chronic pain in general, and chronic visceral pain in particular. It appears that randomized clinical trials have either not been reported or are in the planning stages. Even so, the literature encompassing specific applications, for example, neuromodulation for chronic pelvic pain, contains relatively little actual clinical data, consisting largely of case series and abstracts. Although it was ultimately developed as a standard adjuvant therapy for persistent back and leg pain, interest in its application to visceral pain syndromes has persisted, and its use for that purpose has been explored by a number of researchers. in 1967 as an experimental therapy for visceral cancer pain. Within this general context, spinal cord stimulation was introduced by Shealy et al. Many alternative therapeutic approaches are presently under study, but with results that are either equivocal or yet to be reported. Well-known limitations to treating chronic visceral pain include diagnostic difficulties, dosage ceilings, addiction issues with drug regimens, and patient unwillingness to undergo repeat interventional procedures. Chronic pelvic pain (CPP) affects >25% of women worldwide and >9 million in the United States alone, half of them reporting reduced work capacity, and with direct health care costs approaching 1 billion dollars. The effective management of visceral pain of both non-cancer- and cancer-related origin is of particular importance and has been the focus of research within pharmacology, surgery, and neuromodulation for many years. The search for safe and effective treatments of chronic intractable pain constitutes one of the great ongoing quests of medical science. Spinal Cord Stimulation, Visceral Pain, Postsynaptic Dorsal Column, Dorsal Root Ganglion, Intradural Stimulation Introduction
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |