Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; ITmedico, Aarhus, Denmark; Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark; and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
?? Spinal cord stimulation (SCS) is increasingly gaining widespread use as a treatment for chronic pain. A widely used electronic registry could play a pivotal role in improving this complex and cost-?intensive treatment. We aimed to construct a comprehensive, universally available data base for SCS.
?? The design considerations behind a new online data base for SCS are presented; basic structure, technical issues, research applications, and future perspectives are described.
?? The Aarhus Neuromodulation Database covers core SCS treatment parameters, including procedure-?related details and complications, and features recording of key success parameters such as pain intensity, work status, and quality of life. It combines easy access to patient information with exhaustive data extraction options, and it can readily be adapted and expanded to suit different needs, including other neuromodulation treatment modalities.
?? We believe that the data base described in this article offers a powerful and versatile data collection tool suited for both clinicians and researchers in the field. The basic data base structure is immediately available on a no?-cost basis, and we invite our colleagues to make use of the data base as part of the efforts to further the field of neuromodulation.
OBJECTIVES: To describe the prevalence and character of chronic abdominal pain in a group of patients with long-term spinal cord injury (SCI) and to assess predictors of abdominal pain. STUDY DESIGN: Postal survey. SETTING: Members of the Danish Paraplegic Association. METHODS: We mailed a questionnaire to 284 members of the Danish Paraplegic Association who met the inclusion criteria (member for at least 10 years). The questionnaire contained questions about cause and level of spinal injury, colorectal function and pain/discomfort. RESULTS: Seventy percent returned the questionnaire (133 men and 70 women). Mean age was 47 years. Thirty-four percent reported having chronic abdominal pain or discomfort. Onset of pain was later than 5 years after their SCI in 53%. Low defecation frequency was more common in patients with abdominal pain/discomfort and constipation more often affected their quality of life compared to patients without abdominal pain/discomfort. The most common descriptors were annoying, cramping/tightening, tender, sickening and shooting/jolting. There was no relation to age, time since injury or level of injury, but more women than men reported abdominal pain/discomfort. There was no relation of abdominal pain to other types of pain. CONCLUSION: Chronic pain located in the abdomen is frequent in patients with long-term SCI. The delayed onset following SCI and the relation to constipation suggest that constipation plays an important role for this type of pain in the spinal cord injured.
Although introduced for neurogenic bladder dysfunction, it has been suggested that the artificial somato-autonomic reflex arch alleviates neurogenic bowel dysfunction (NBD). We aimed at evaluating the effects of the reflex arch on NBD.
Ten subjects with supraconal spinal cord injury (SCI) (nine males, median age 46 years) had an anastomosis created between the ventral part of the fifth lumbar or first sacral nerve root and the ventral part of the second sacral nerve root. Standardized assessment of segmental colorectal transit times with radiopaque markers, evaluation of scintigraphic assessed colorectal emptying upon defecation, scintigraphic assessment of colorectal transport during stimulation of the reflex arch, standard anorectal physiology tests and colorectal symptoms were performed at baseline and 18 months after surgery.
No significant change was observed in colorectal emptying upon defecation (median 31% of the rectosigmoid at baseline vs 75% at follow-up, P=0.50), no movement of colorectal contents was observed during stimulation of the reflex arch. Segmental colorectal transit times, anal sphincter pressures and rectal capacity did not change, and no change was seen in NBD score (median 13.5 (baseline) vs 12.5 (follow-up), P=0.51), St Marks fecal incontinence score (4.5 vs 5.0, P=0.36) and Cleveland constipation score (6.0 vs 8.0, P=0.75).
The artificial somato-autonomic reflex arch has no effect on bowel function in subjects with supraconal SCI.
Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI.
As soon as possible after SCI patients who met the inclusion criteria had 24?h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI.
Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P=0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients.
The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached.
To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences.
Cross-sectional survey in Denmark.
A 35-item questionnaire was sent to 1,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012.
A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas/larger cities, tobacco-smoking, high alcohol intake and higher muscle stiffness were significantly associated with cannabis use. Those who had never tried cannabis reported that they would mainly use cannabis to alleviate pain and spasticity if it were legalized.
Cannabis use is more frequent among individuals with spinal cord injury in Denmark than among the general population. High muscle stiffness and various demographic characteristics (lower age, living in rural areas/larger cities, tobacco-smoking and high alcohol intake) were associated with cannabis use. Most participants had started using cannabis before their spinal cord injury. There was considerable overlap between recreational and disability-related use.
This prospective study reports the clinical and epidemiological features of 187 consecutive patients with neuroborreliosis recognized in Denmark over the 6-yr period, 1985-1990. Only patients with intrathecal Borrelia burgdorferi specific antibody synthesis were included. In 1990 regional incidences varied between 5.7 and 24.1 per million. Ninety-four percent of the patients had early (second stage) neuroborreliosis. The most common manifestation was a painful lymphocytic meningoradiculitis (Bannwarth's syndrome) either with paresis (61%) or as a radicular pain syndrome only (25%). Central nervous system (CNS) involvement in early neuroborreliosis was rare; 4% had signs of myelitis and only one patient had acute encephalitis. Children showed a different course of the disease. Six percent of the patients suffered a chronic course with a disease duration between 6 mths and 6 yrs either as chronic lymphocytic meningitis (1.6%) or as third stage chronic encephalomyelitis (4.3%). Meningeal signs were rare despite pronounced inflammatory cerebrospinal fluid (CSF) changes (median cell count 160/microliters; median protein concentration 1.13 g/l). High dose i.v. penicillin G was administered to 91% of the patients. Based on the clinical outcome and normalization of CSF no treatment failures were recognized. The final morbidity after a median follow-up of 33 mths was low; disabling sequelae were reported in nine patients, mainly those with previous CNS involvement. We conclude that neuroborreliosis is a common and characteristic neurological disorder. The diagnosis should be based on the demonstration of inflammatory CSF changes and B. burgdorferi specific intrathecal antibody production.
Since August 1988, in Odense Hospital, electric spinal cord stimulation (SCS) has been employed for the treatment of pain in patients with confirmed ischaemic heart disease who suffer from incapacitating angina pectoris despite maximal medical/surgical treatment. The object of the present investigation was to assess not only the social economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients (perception of pain, mobility, function in daily life and physical activity). Sixteen consecutive SCS patients all of whom were resident in the County of Funen and who were submitted to implantation of an SCS system during the period August 1988 to December 1989, participated in this investigation. The results are based on data from the year prior to SCS implantation compared with the subsequent time with SCS treatment. Saving was found at hospital level (reduction in number of admissions) og 40,200 Danish crowns/annum/patient (approximately IJ 3,000) (1989 prices), and for non-hospital related expenses a corresponding saving of 16,289 Danish crowns/annum/patient (approximately IJ 1,600) was found mainly on account of reduction in the amount of home nursing required. The total saving was found to constitute 56,489 Danish crowns/annum/patient (approximately IJ 5,600). In addition, improvements were registered in all respects which constituted assessment of the quality of life of the patients.
To investigate the extent of renal deterioration in patients with spinal cord injury (SCI) and to identify risk indicators associated with renal deterioration.
Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbæk, Denmark.
This study included 116 patients admitted to our clinic with a traumatic SCI sustained between 1956 and 1975. Results from renography and (51)Cr-EDTA plasma clearance were collected from medical records from time of injury until 2012, and the occurrence of renal deterioration was analysed by cumulative incidence curves. The impact of demographics, neurological level and completeness of SCI, urinary tract stones, dilatation of the upper urinary tract (UUT) and bladder-emptying methods were analysed with Cox proportional hazard ratios.
The bladder-emptying methods used for the longest period were reflex triggering (63%), bladder expression (22%), indwelling catheter (5%), normal voiding (4%), ileal conduit (3%) and clean intermittent catheterisation (2%). The cumulative risk of moderate renal deterioration (functional distribution outside 40-60% on renography or relative glomerular filtration rate (GFR) ?75% of expected according to age and gender) was 58%. The cumulative risk of severe renal deterioration (functional distribution outside 30-70% on renography or relative GFR?51%) was 29% after 45 years postinjury. Only dilatation of UUT and renal/ureter stone requiring removal significantly increased the risk of moderate and severe renal deterioration.
Renal deterioration occurs at any time after injury, suggesting that lifelong follow-up examinations of the renal function are important, especially in patients with dilatation of UUT and/or renal/ureter stones.
OBJECTIVE: Assessment of home aids, adaptations and personal assistance received after traumatic spinal cord injury (SCI). SETTING: Clinic for Spinal Cord Injuries, Denmark. Uptake area, 2.5 million inhabitants. STUDY DESIGN AND METHODS: Cross-sectional follow-up with retrospective data from medical files. MATERIALS: Individuals with traumatic SCI before 1 January 1991, still in regular follow-up and with sufficient medical record. In all, 279 were included, and 236 answered the questionnaire (193 men and 43 women), with a response rate of 84.6%. Mean age at follow-up was 50.5 years, and mean follow-up time, 24.1 years. One hundred and twenty-six were paraplegic and 110, tetraplegic. Responders and non-responders were comparable. RESULTS: Most common aids or adaptations reported were commode/shower chair on wheels or a seat (69%), grab bar by the toilet (41%), electrical bed (44%), special mattress (28%), lift/hoist (20%), computers (39%) and kitchen tools or cutlery with special handles (14%). In all, 7.6% of the participants reported no aids. Eighty-two percent answered 'Yes' to the question 'Have the aids, you currently or previously needed, been available to you?' The majority reported that their source of information about aid had been various journals and magazines. Twenty-one percent had personal helpers, with 60 h per week in median (range 2-168). Thirty-three percent received domestic help with 2.5 h per week in median (range 0.5-37). Eight percent had a home nurse. A total of 98.7% were living in their own homes. CONCLUSIONS: This is the first study of a representative SCI population giving information on home aids. Individuals with SCI in Denmark seem to be sufficiently supplied with aids and personal assistance.