Background
Central neuropathic pain related to spinal cord injury is notoriously difficult to treat. So far most pharmacological and surgical options have shown but poor results. Recently ziconotide has been approved for use both neuropathic and non‐neuropathic pain. In this cohort study, we assessed responder rate and long‐term efficacy of intrathecal ziconotide in patients with pain related to spinal cord injury.
Methods
Patients presenting chronic neuropathic related to spinal cord lesions that was refractory to medical pain management were considered for inclusion. Those accepting were tested by lumbar puncture injection of ziconotide or continuous intrathecal infusion and if a significant decrease in pain scores (>40%) was noted they were implanted with a continuous infusion pump. They were then followed up for at least 1 year with constant assessment of the evolution of pain and side effects.
Results
Out of the 20 patients tested 14 had a decrease in pain scores of more than 40% but only 11 (55%) were implanted with permanent pumps due to side effects and patient choice. These were followed up on average for 3.59 years (±1.94) and in eight patients an above threshold decrease in pain scores was maintained. Overall in patients that responded to the test baseline VAS was 7.91 and 4.31 at last follow‐up with an average dose of 7.2 μg of ziconotide per day. Six patients (30%) did not respond to any test and in three patients side effects precluded pump implantation. No significant long‐term effects of the molecule were noted.
Conclusion
This study shows response to intrathecal ziconotide test in 40% of the patients of a very specific population in whom other therapeutic options are not available. This data justifies the development further studies such as a long‐term randomized controlled trial.
Significance
Intrathecal Ziconotide is a posible alternative for the treatment of pain in patients with spinal cord injury and below level neuropathic pain.
High levels of vibration exist in helicopters and manufacturers are seeking to quantify vibration discomfort. They use the ISO 2631-1 standard, proposed for all types of transport. This study aimed to verify the validity of this index in the specific case of helicopters. Perception tests were carried out in the laboratory. Volunteers assessed the discomfort of vibratory stimuli on test benches generating vertical and triaxial vibrations. Foot, seat and backrest accelerations were measured for each participant according to each stimulus. The ISO 2631-1 comfort indices were then compared with the evaluations given by the participants. The results showed that the standard provided a good estimate of discomfort. However, it lacks precision in estimating the discomfort of stimuli which include amplitude modulations, as can happen in helicopters. A new discomfort index is proposed based on ISO 2631-1 and allows better prediction of subjective assessments.
International audienceThis paper considers the identification problem for 2D-structures by comparing a modal method with a new method based on the estimation of the dispersion equation in k-space. Both methods are validated by numerical simulation and by measurements based on an acoustic holography experiment
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