[Flupirtine in comparison with chlormezanone in chronic musculoskeletal back pain. Results of a multicenter randomized double-blind study].

Method: The analgesic and muscle-relaxing properties of flupirtine maleate, chlormezanone and placebo were compared in a total of 184 patients. Of these patients, 164 met the criteria of the treatment plan (intention to treat), and the data of 140 patients were finally evaluated in accordance with the test protocol. A positive response was defined as a reduction in pain intensity and muscle tension by 2 categories on the 5-category verbal scale "very severe/severe/moderate/mild/ none" on the seventh day of treatment.

[Technical development of spinal neurostimulation.].

The rationale for the use of spinal cord stimulation (SCS) in the treatment of chronic pain arose from Melzack and Wall's gate theory of the control of pain (1965). Originally electrodes were placed directly on the spinal cord via open operation, while now they are placed by means of direct puncture the epidural space. In most cases, one of two different systems is used: (1) semi-implants, consisting of an implantable electrode, connection cable and receiver, and externally worn stimulator with antenna; (2) full implants, consisting of an implantable electrode, connection cable and a stimulator, which is also implanted.

Spinal cord transmission of impulses during high spinal anesthesia as measured by cortical evoked potentials.

Cortical evoked potentials (CEPs) resulting from posterior tibial nerve stimulation could be recorded before, but not during, diagnostic high spinal anesthesia to T2-3 in six patients with chronic pain. In contrast, spinal cord stimulation at T8-9 during high spinal anesthesia resulted in CEPs with reduced peak amplitudes and increased P1 and N2 latencies. Amplitudes of the CEPs evoked by spinal cord stimulation increased with increases in stimulus intensity before and during high spinal anesthesia (N = 3).

Sacroiliac joint arthrodesis for chronic lower back pain.

We report our experience with sacroiliac joint arthrodesis in cases of overt osteoarthritis. Twenty-two operations were performed over a period of 3.5 years and reviewed between 12 and 55 months postoperatively.

Pain reduction in amputees by long-term spinal cord stimulation. Long-term follow-up study over 5 years.

This follow-up study analyzes the results of dorsal column stimulation instituted between 1972 and 1974 for the relief of pain in 84 patients, including 64 amputees. Good results decreased from 52.4% after 2 years of stimulation to 39% after 5 years.

Medial thalamic permanent electrodes for pain control in man: an electrophysiological and clinical study.

In 7 patients with medial thalamic electrodes implanted for relief of chronic pain, clinical observations and electrophysiological recordings showed: (1) Clinically, paresthesia in the pain area and contralateral half of the body was reported as well as some unpleasant side effects. The EEG was not changed during medial thalamic stimulation. (2) Threshold for non-painful and painful perception of electrical stimuli were not significantly raised by contralateral medial thalamic stimulation.

Pain perception in man after long term spinal cord stimulation.

Thresholds of non-painful and painful perception for electrical stimuli are not altered significantly during dorsal column stimulation either in the area of induced paresthesia or outside it. After long term stimulation of the dorsal column the thresholds for stimuli are significantly higher within the area of induced paresthesia but not outside it. Median nerve evoked somatosensory cortical potentials are not altered by conditioning or simultaneous DC stimulation.

Electrical spinal cord stimulation for spastic movement disorders.

Spinal cord stimulation seems today a promising method to improve spasticity. The experiences of two different clinics (Zürich and Freiburg i.Br.

Influence of transcutaneous nerve stimulation (TNS) on acute pain.

Using transcutaneous nerve stimulation (TNS) simple surgical procedures such as tooth extractions and nerve biopsies can be performed without the usual anesthetics. Estimation of threshold and suprathreshold intensities of painful electrical stimuli show no significant change during TNS. Only the threshold for non-painful electrical stimuli is slightly increased.

Influence of dorsal column stimulation (DCS) on spastic movement disorders.

Dorsal column stimulation in two spastic patients with upper motor neurone disease showed the following effects: 1. The subjective feeling of stiffness decreased. During DCS patients were able to walk longer distances without rest.

[Methods of pain modulation by electrical stimulation (author's transl)].

Different methods of modulating pain by electrical stimulation are described: (1) Nondestructive transcutaneous nerve stimulation is recommended for neurogenic pain syndromes prior to other procedures (success rate about 30%); (2) The implantation of electrodes on the dorsal columns yields good effects in 65% after careful selection; (3) First results with implantations in deep brain structures are discussed.

[Pain phenomena in amputees. Clinical features, evaluation of tests and possibilities of treatment (author's transl)].

The clinical phenomena in amputees can be clearly divided into phantom pain, painful stumps and stump pulsation. The various causal mechanisms are described as a basis for the differing assessments of treatment and also compared with our own observations and results.

[Pain suppression in the trigeminal region by means of transcutaneous nerve stimulation].

On the basis of the gate control theory, an attempt was made to influence acute pain by transcutaneous nerve stimulation (TNS) in the region of the trigeminal nerve. After favorable first results in clinical application, we determined sensation and pain treshold values of teeth in two groups of patients by exactly defined electric stimuli of different degrees. After transcutaneous electro-stimulation of the pertinent ramus of the trigeminal nerve with rectangular stimulating currents, the threshold measurements were repeated.

Spinal cord stimulation in post-amputation pain.

One of the pre-operative screening tests for dorsal column stimulation involves direct acute precutaneous stimulation of the dorsal column. The test simulates the postoperative therapeutic situation, shows the patient's reactions to electrically induced paresthesias and enables physician and patient to evaluate beforehand the degree of pain relief to be obtained with the implant.

Experience with dorsal column stimulation (DCS) in the operative treatment of chronic intractable pain.

The results of DCS in 50 patients are altogether favourable; they are better for the group of amputation and phantom pain than for the group of peripheral nerve lesions. For patients with malignoma pain no valid comment can be given. The influence of DCS is mostly immediate in bouts of acute pain, slower in chronic permanent pain, where a longer period of stimulation is needed.