Age: 63
Sex: Male
History: Recurrant pain lower back midline and radiation down both legs, more marked on the right side.
- 1958 -- Lumbar disc surgery - Partial benefit.
- 1960 -- Exacerbation of symptoms.
- 1967 -- Laminectomy of L3-4.
- 1978 -- Disc extrusion L4-5.
- 1980 -- Intractable bilateral sciatic pain, worse on the right and was on narcotics.
- 1981 -- Managed by the Pain Management Clinic and subsequently underwent the following pain relief procedures:
- 1988 -- A deep brain elctrode implant in the left paraventricular grey -- Good result.
- 1993-94 -- Developed tolerance -- Recurrant pain.
- 1994 -- A deep brain electrode implant in the right paraventricular grey, (opposite hemisphere) resumption of pain control.
- 1998 -- Again he started to show reduction in the pain control. His connector pins were explored, cleaned and reconnected with the resumption of pain control.
- 1999 -- Again fading of pain control in spite of stimulation. The right electrode which was giving him partial pain control at present. Stimulation holiday not helping.
QUESTION:
What to do next when the deep brain electrodes on either side are staring to fail? Tolerance.
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