Management Options for Angina Refractory to Maximal Medical and Surgical Interventions

Neurosurgical Treatment of Pain

The aim of this review is to draw attention to neurosurgical approaches for treating chronic and opioid-resistant pain. In a first chapter, an up-to-date overview of the main pathophysiological mechanisms of pain has been carried out, with special emphasis on the details in which the surgical treatment is based. In a second part, the principal indications and results of different surgical approaches are reviewed. Cordotomy, Myelotomy, DREZ lesions, Trigeminal Nucleotomy, Mesencephalotomy, and Cingulotomy are revisited. Ablative procedures have a limited role in the management of chronic non-cancer pain, but they continues to help patients with refractory cancer-related pain. Another ablation lesion has been named and excluded, due to lack of current relevance. Peripheral Nerve, Spine Cord, and the principal possibilities of Deep Brain and Motor Cortex Stimulation are also revisited. Regarding electrical neuromodulation, patient selection remains a challenge.

Output of Electronic Muscle Stimulators: Physical Therapy and Police Models Compared

INTRODUCTION

Both physical therapists and police officers use electrical muscle stimulation. The typical physical therapist unit is attached with adhesive patches while the police models use needle-based electrodes to penetrate clothing. There have been very few papers describing the outputs of these physical therapy EMS (electrical muscle stimulator) units.

METHODS

We purchased 6 TENS/EMS units at retail and tested them with loads of 500 Ω, 2 kΩ, and 10 kΩ.

RESULTS

For the typical impedance of 500 Ω, the EMS units delivered the most current followed by the electrical weapons; TENS units delivered the least current. At higher im-pedances (> 2 kΩ) the electrical weapons delivered more current than the EMS units, which is explained by the higher voltage-compliance of their circuits. Some multi channel EMS units deliver more calculated muscle stimula tion than the multi-channel weapons.

CONCLUSION

Present therapeutic electrical muscle stimula-tors can deliver more current than present law-enforcement muscle stimulators.

Coping with Phantom Limb Pain

Phantom limb pain is a chronic neuropathic pain that develops in 45-85% of patients who undergo major amputations of the upper and lower extremities and appears predominantly during two time frames following an amputation: the first month and later about 1 year. Although in most patients the frequency and intensity of pain diminish over time, severe pain persists in about 5-10%. It has been proposed that factors in both the peripheral and central nervous systems play major roles in triggering the development and maintenance of pain associated with extremity amputations. Chronic pain is physically and mentally debilitating, affecting an individual's capacity for self-care, but also diminishing an individual's daily capacity for personal and economic independence. In addition, the pain may lead to depression and feelings of hopelessness. A National Center for Biotechnology Information study found that in the USA alone, the annual cost of dealing with neuropathic pain is more than $600 billion, with an estimated 20 million people in the USA suffering from this condition. Although the pain can be reduced by antiepileptic drugs and analgesics, they are frequently ineffective or their side effects preclude their use. The optimal approach for eliminating neuropathic pain and improving individuals' quality of life is the development of novel techniques that permanently prevent the development and maintenance of neuropathic pain, or that eliminate the pain once it has developed. What is still required is understanding when and where an effective novel technique must be applied, such as onto the nerve stump of the transected peripheral axons, dorsal root ganglion neurons, spinal cord, or cortex to induce the desired influences. This review, the second of two in this journal volume, examines the techniques that may be capable of reducing or eliminating chronic neuropathic pain once it has developed. Such an understanding will improve amputees' quality of life by blocking the mechanisms that trigger and/or maintain PLP and chronic neuropathic pain.

Cardiac effects of varying pulse charge and polarity of TASER conducted electrical weapons

The TASER(R) CEW (Conducted Electrical Weapon) is rapidly replacing the club in the English-speaking world for assisting in the arrest of resistant subjects and is now used by the majority of law enforcement agencies in the USA, Canada, and the UK. Animal safety studies of the CEW have focused on the risk of VF. We sought to determine the difference in cardiac capture and VF risk between the approximately 102 +/- 8 microC of the ubiquitous X26 and a me-tered 72 microC charge from an experimental device. It is well established from the bidomain theory and experimental data that a pacing electrode will capture the heart with significantly lower charge when the electrode touching the cardiac tissue is a cathode However, experimental data show that there is no difference in the ability of the anode vs the cathode to induce VF. We sought to evaluate the effect of polarity changes on cardiac capture and the induction of VF. Small swine ( approximately 20.0 kg) were anesthetized and ventilated. The apex of the heart was located via echocar-diography and a CEW probe was fully inserted towards the apex. Echocardiography was used to monitor cardiac contractions to determine cardiac capture. Both the X26 and the 72 microC pulses were delivered at both polarities to test for cardiac capture. Higher charge pulses (375 microC) were then delivered with both polarities to test for VF risk. The 72 microC experimental unit was unable to cause cardiac capture even in small swine with fully inserted probes directly over the apex of the heart. We found no polarity effect in the risk of VF in small swine with larger charge ( approximately 5x) pulses.