Anesth Analg 2001;92:483-487
© 2001 International Anesthesia Research Society
REGIONAL ANESTHESIA AND PAIN MEDICINE
The Effect of Montage on the Analgesic Response to Percutaneous Neuromodulation Therapy
Paul F. White, PhD, MD, FANZCA,
El-sayed A. Ghoname, MD,
Hesham E. Ahmed, MD,
Mohammed A. Hamza, MD,
William F. Craig, MD, and
Akshay S. Vakharia, MD
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
Address correspondence to Paul F. White, PhD, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5161 Harry Hines Blvd., CS.2.202, Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu
The analgesic response to percutaneous neuromodulation therapy (PNT) is influenced by the location, frequency, and duration of electrical stimulation. We evaluated the effect of different patterns of stimulation (montages) on the acute analgesic response to PNT when applied at the same dermatomal levels in 72 consenting patients with low back pain. All of the patients received a standardized montage (I) and three alternative montage (II–IV) patterns according to a randomized, single-blinded, crossover study design. All of the PNT treatments were administered at identical alternating stimulation frequencies of 15 and 30 Hz for a period of 30 min, three times per week for two consecutive weeks, with 1 wk "off" between each modality. Pretreatment assessments included the health status survey short form (SF-36) questionnaire, as well as visual analog scale scores for pain, physical activity, and quality of sleep (with 0 = the best to 10 = the worst). The pain visual analog scale was repeated 5–10 min after each treatment session. The daily oral analgesic usage was recorded in a patient diary. All four montages produced significant improvements in pain (42%–64%), physical activity (35%–51%), and quality of sleep (28%–46%), as well as 23% to 47% reductions in the daily oral analgesic usage. However, Montage II was significantly more effective than the standard (Montage I) and the other two montages studied. These data suggest that the pattern of stimulation (i.e., montage) can influence the acute analgesic response to PNT.
Implications: With electroanalgesic techniques such as percutaneous neuromodulation therapy, the pattern of the electrical stimulation can influence the acute analgesic response even when identical stimuli are administered at the same dermatomal levels.
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