Elliot Krames - Academia.edu (original) (raw)

Papers by Elliot Krames

Neuromodulation: Technology at the Neural Interface, 2008

Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appr... more Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods. Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. Subjects reported pain ratings (visual analog scale) with stimulation off and stimulation on at scheduled follow-up visits for up to 18 months after activation of the system. Visual analog scale scores were averaged and stratified by dominant pain etiologies, comprising failed back surgery syndrome, complex regional pain syndrome, and a subgroup of subjects with miscellaneous other pain etiologies. Results. More than 70% of subjects in each subgroup had successful outcomes during the temporary trial period and similar percentages of subjects from each etiology subgroup subsequently went on to permanent implantation. After permanent implantation, all subgroups reported more than 50% pain relief, on average, at each follow-up time point. No predictive value of pain etiology was obser ved. Conclusions. Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surger y syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.

Neuromodulation: Technology at the Neural Interface, 2007

Objectives. A prospective, open label, multicenter clinical trial confirmed the functionality of ... more Objectives. A prospective, open label, multicenter clinical trial confirmed the functionality of a new spinal cord stimulation (SCS) system for the treatment of chronic, intractable pain of the trunk and/or limbs. Materials and Methods. Sixty-five subjects tested a rechargeable 16-channel SCS system with individual current control of each contact on one or two percutaneous eight-contact epidural leads. After baseline measurements, subjects were tracked on pain ratings and complication rates for up to 18 months. Results. After a trial period, 75% of subjects underwent permanent implantation of the entire SCS system. More than one-half the implanted subjects experienced 50% or greater relief of pain after permanent implantation; some subjects reported relief of 90% or more of their pain. The most common complications after permanent implantation were lead migration, uncomfortable stimulation, and component failure; most resolved after reprogramming or device replacement. Conclusions. The new SCS system provided good pain relief to a majority of subjects, and the results confirm a favorable safety and efficacy profile for the SCS system.

Neuromodulation: Technology at the Neural Interface, 1998

OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal d... more OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal drug delivery systems is particularly distressing. An attempt was made to determine the extent of this problem in both reported and in heretofore unreported cases. Methods. A survey was mailed to 3269 implanters of intraspinal infuslonal systems to identify new cases of neurological sequelae of pump implantation. 51 9 out of 3269 surveys mailed out responded. Resu/fs. There were 488 "no" respondents and 31 "yes" respondents to the question: "did any patient of yours develop neurologic sequelae or granulomatous catheter mass formation after implant of their intraspinal catheters?" 6 new, heretofore unreported cases of granulomatous mass formations at catheter tips were reported. 27 cases of neurological sequelae due to other etiologies were also noted. Also presented in this paper are 4 case reports to augment reader understanding of the problem. Conc/usions. The problem of post-implant neurological sequelae is potentially devastating. Increased vigilance for early diagnosis may prevent the development of permanent paralysis. Gadolinium enhanced MRI scanning at the catheter tip is the imaging study of choice for diagnosis. Any patient developing a new area of Reprint requests to E. Kromes, M 0 , Pociflc Pain Treatment Centers, One Daniel Burnhom Court #350-C. San Francisco. CA 94109 USA pain, weakness or rapid escalation in intrathecal drug dose should be thoroughly assessed. H

Journal of Pharmaceutical Care in Pain & Symptom Control, 1997

Management strategies for chronic, nonmalignant pain are described. The need for more effective m... more Management strategies for chronic, nonmalignant pain are described. The need for more effective management of this type of pain is clear. To achieve this, it is essential to recognize the multidimensional nature of chronic, nonmalignant pain. A continuum including nonsteroidal antiinflammatory drugs (NSAIDs), antidepressants, anticonvulsants, autonomic agents and other medications is described. A place for opioids in this continuum is defined. Barriers to appropriate use of opioids are discussed, including concerns about regulatory sanctions. Tolerance, dependence and addiction are differentiated. The rational use of opioids in nonmalignant pain management is described in the context of interdisciplinary, multimodal care.

Frontiers in Neurology

Since the outbreak of the COVID-19 pandemic, races across academia and industry have been initiat... more Since the outbreak of the COVID-19 pandemic, races across academia and industry have been initiated to identify and develop disease modifying or preventative therapeutic strategies has been initiated. The primary focus has been on pharmacological treatment of the immune and respiratory system and the development of a vaccine. The hyperinflammatory state (“cytokine storm”) observed in many cases of COVID-19 indicates a prognostically negative disease progression that may lead to respiratory distress, multiple organ failure, shock, and death. Many critically ill patients continue to be at risk for significant, long-lasting morbidity or mortality. The human immune and respiratory systems are heavily regulated by the central nervous system, and intervention in the signaling of these neural pathways may permit targeted therapeutic control of excessive inflammation and pulmonary bronchoconstriction. Several technologies, both invasive and non-invasive, are available and approved for clini...

Postgraduate Medicine

ABSTRACT Objective: In the treatment of chronic diseases, remission is commonly used as a meaning... more ABSTRACT Objective: In the treatment of chronic diseases, remission is commonly used as a meaningful treatment goal, synonymous with the absence of significant clinical signs and symptoms of a disease, but not representing a cure. The objective of this paper is to propose a definition for remission for use as an outcome to evaluate the long-term efficacy of therapies for chronic pain. Methods: Data from a randomized clinical trial (NCT01609972) testing the efficacy of spinal cord stimulation in low back and leg pain subjects was used to evaluate the association between pain and functional outcomes and identify the cut-off value to predict remission. Available data over 24-month assessment period included visual analog score (VAS), disability (Oswestry Disability Index [ODI]), patient and clinician global impression of change (PGIC and CGIC), and patient satisfaction. Cluster analysis, Pearson’s correlation coefficients, sensitivity, and specificity analyses were used to evaluate its utility in predicting higher patient functionality and satisfaction. Results: Though the term remission has been used in the chronic pain field, a consistent definition has not been previously established. Based on the analysis of the clinical data, we propose that a sustained (≥6 months) pain score of ≤3.0 cm out of 10 cm on VAS be defined as remission. Applying this definition to the clinical trial data: subjects in remission at 24 months versus non-remitters were significantly more likely to be in the highest functional category of minimally disabled according to the ODI (31.5 vs. 8.2%, respectively, p = 0.001), and be ‘very satisfied’ (75.7 vs 22.6%, respectively, p < 0.001). Conclusions: The validity of the proposed definition of remission is supported by the persistence of remission in this study group, and its correspondence with patient satisfaction, and reduced disability. Further evaluation of the definition using clinical data from other long-term studies is needed. Trial registration: ClinicalTrials.gov identifier: NCT01609972.

Surgical technology international, 1991

There has recently been an increased interest in the safety, efficacy and relative ease in the de... more There has recently been an increased interest in the safety, efficacy and relative ease in the delivery of intraspinal analgesics for the control of intractable pain. Recent technological advances have provided clinicians with precise and accurate delivery systems for long term infusion of spinally administered drugs. Because of these advances, there has been a rapidly growing interest in long term intraspinal infusional therapy for the control of chronic pain.

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease stat... more Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. Th...

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or per... more Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation. The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in w...

Neuromodulation, 2006

I have lost a true and great friend. Writing this eulogy for such a man as John Oakley does not b... more I have lost a true and great friend. Writing this eulogy for such a man as John Oakley does not belong to one person, for John Oakley was a friend, a colleague, and a mentor to many from all over our planet. But for me, John was not only a friend and mentor, but also a model of how I want to be perceived in this world. John was a model of DOING, of love, passion, intelligence, quick wit, ethics, loyalty, and caring. John was a human's human. I will miss him terribly. So will his family, his friends, his colleagues, and the wide, wide world in which John chose to participate. John Oakley died at the very tender age of 60 on April 17, 2006. He was born January 11, 1946, in Seattle, Washington. John was the second child of a family of six children. He was the son of and is survived by Donald and Beulah Oakley. He is survived by brothers Robert and Steve and sisters Nancy Manning, Sally Sheehan, and Donna Oakley. John is survived by his wife, Shirley; his sons John, Jr., and Peter; his daughter, Rebekah; and his grandchildren, John Christian, age 9, Alan, age 5, and Anna, just 3 days old. According to his wife, Shirley, whom he married on June 20, 1969, John's first passion was history and religion and he wanted to pursue either a career as a minister in the Lutheran church or a career as a professor of history. John began his college education at the University of Washington in 1964, but finished his college education at Pacific Lutheran University in 1968, where he graduated, magna cum laude. But as many human stories go, and as luck has it for all of us, John did not choose to pursue a career in either the ministry or history; he chose medicine. After medical school training at the University of Washington in Seattle, where he graduated from in 1972, John interned at Cincinnati General Hospital and completed his residency training in neurosurgery at the University of Washington. After completion of his neurosurgical training, John started his career at the National Institutes of Health before becoming a professor of neurosurgery under the tutelage of Phillip Weinstein, chairman of the Department of Neurosurgery at the University of Arizona, where John spent 2 years. After Arizona, John chose to come back to Seattle, Washington, the place of his birth, and spent the next 17 years in the private practice of neurosurgical medicine at Northwestern Hospital in Seattle. John

Pain Reviews, Nov 30, 1995

Neuromodulation and Chronic Pain Theodosiadis P, Samoladas E, Grosomanidis V, Karakoulas K, Vasil... more Neuromodulation and Chronic Pain Theodosiadis P, Samoladas E, Grosomanidis V, Karakoulas K, Vasilakos D Chronic pain causes extreme suffering for millions of people worldwide. It is the leading cause for lost workdays and patients often undergo expensive courses of treatment. Because chronic pain is often difficult to relieve for sustained periods of time, it can have a significant impact on

Acta neurochirurgica. Supplement, 2007

Operative neuromodulation is the field of altering electrically or chemically the signal transmis... more Operative neuromodulation is the field of altering electrically or chemically the signal transmission in the nervous system by implanted devices in order to excite, inhibit or tune the activities of neurons or neural networks and produce therapeutic effects. It is a rapidly evolving biomedical and high-technology field on the cutting-edge of developments across a wide range of scientific disciplines. The authors review relevant literature on the neuromodulation procedures that are performed in the spinal cord or peripheral nerves in order to treat a considerable number of conditions such as (a) chronic pain (craniofacial, somatic, pelvic, limb, or due to failed back surgery), (b) spasticity (due to spinal trauma, multiple sclerosis, upper motor neuron disease, dystonia, cerebral palsy, cerebrovascular disease or head trauma), (c) respiratory disorders, (d) cardiovascular ischemia, (e) neuropathic bladder, and (f) bowel dysfunction of neural cause. Functional neuroprosthetics, a fiel...

Neuromodulation : journal of the International Neuromodulation Society, 2015

In the not-too-distant past, the dorsal root ganglion (DRG) was portrayed as a passive neural str... more In the not-too-distant past, the dorsal root ganglion (DRG) was portrayed as a passive neural structure without involvement in the development or maintenance of chronic neuropathic pain (NP). The DRG was thought of as a structure that merely "supported" physiologic communication between the peripheral nervous system (PNS) and the central nervous system (CNS). Newer scientific information regarding the anatomic and physiologic changes that occur within the DRG as a result of environmental pressures has dispelled this concept and suggests that the DRG is an active participant in the development of NP. This new information, along with new clinical data showing that stimulation of the DRG reduces intensity of pain, suggests that the DRG can be a robust target for neuromodulation therapies. A review of the anatomical and physiological literature regarding the role of the DRG in the development of NP was performed utilizing SciBase, PubMed, and Google Scholar. The information ga...

The journal of supportive oncology

Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and... more Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and their families is staggering. Spinal cord stimulation for the treatment of chronic pain is cost-effective when used in the context of a pain treatment continuum. Many theories on the mechanism of action of spinal cord stimulation have been suggested, including activation of gate control mechanisms, conductance blockade of the spinothalamic tracts, activation of supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms, and activation or release of putative neuromodulators. Whatever theory or theories of mechanism are correct, spinal cord stimulation has efficacy in the treatment of failed back surgery syndrome, complex regional pain syndromes, intractable pain due to peripheral vascular disease, and intractable pain due to angina.

Neuromodulation: Technology at the Neural Interface, 2008

Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appr... more Objectives. The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods. Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. Subjects reported pain ratings (visual analog scale) with stimulation off and stimulation on at scheduled follow-up visits for up to 18 months after activation of the system. Visual analog scale scores were averaged and stratified by dominant pain etiologies, comprising failed back surgery syndrome, complex regional pain syndrome, and a subgroup of subjects with miscellaneous other pain etiologies. Results. More than 70% of subjects in each subgroup had successful outcomes during the temporary trial period and similar percentages of subjects from each etiology subgroup subsequently went on to permanent implantation. After permanent implantation, all subgroups reported more than 50% pain relief, on average, at each follow-up time point. No predictive value of pain etiology was obser ved. Conclusions. Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surger y syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.

Neuromodulation: Technology at the Neural Interface, 2007

Objectives. A prospective, open label, multicenter clinical trial confirmed the functionality of ... more Objectives. A prospective, open label, multicenter clinical trial confirmed the functionality of a new spinal cord stimulation (SCS) system for the treatment of chronic, intractable pain of the trunk and/or limbs. Materials and Methods. Sixty-five subjects tested a rechargeable 16-channel SCS system with individual current control of each contact on one or two percutaneous eight-contact epidural leads. After baseline measurements, subjects were tracked on pain ratings and complication rates for up to 18 months. Results. After a trial period, 75% of subjects underwent permanent implantation of the entire SCS system. More than one-half the implanted subjects experienced 50% or greater relief of pain after permanent implantation; some subjects reported relief of 90% or more of their pain. The most common complications after permanent implantation were lead migration, uncomfortable stimulation, and component failure; most resolved after reprogramming or device replacement. Conclusions. The new SCS system provided good pain relief to a majority of subjects, and the results confirm a favorable safety and efficacy profile for the SCS system.

Neuromodulation: Technology at the Neural Interface, 1998

OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal d... more OBJECTIVES. The development of neurological sequelae subsequent to the placement of intraspinal drug delivery systems is particularly distressing. An attempt was made to determine the extent of this problem in both reported and in heretofore unreported cases. Methods. A survey was mailed to 3269 implanters of intraspinal infuslonal systems to identify new cases of neurological sequelae of pump implantation. 51 9 out of 3269 surveys mailed out responded. Resu/fs. There were 488 "no" respondents and 31 "yes" respondents to the question: "did any patient of yours develop neurologic sequelae or granulomatous catheter mass formation after implant of their intraspinal catheters?" 6 new, heretofore unreported cases of granulomatous mass formations at catheter tips were reported. 27 cases of neurological sequelae due to other etiologies were also noted. Also presented in this paper are 4 case reports to augment reader understanding of the problem. Conc/usions. The problem of post-implant neurological sequelae is potentially devastating. Increased vigilance for early diagnosis may prevent the development of permanent paralysis. Gadolinium enhanced MRI scanning at the catheter tip is the imaging study of choice for diagnosis. Any patient developing a new area of Reprint requests to E. Kromes, M 0 , Pociflc Pain Treatment Centers, One Daniel Burnhom Court #350-C. San Francisco. CA 94109 USA pain, weakness or rapid escalation in intrathecal drug dose should be thoroughly assessed. H

Journal of Pharmaceutical Care in Pain & Symptom Control, 1997

Management strategies for chronic, nonmalignant pain are described. The need for more effective m... more Management strategies for chronic, nonmalignant pain are described. The need for more effective management of this type of pain is clear. To achieve this, it is essential to recognize the multidimensional nature of chronic, nonmalignant pain. A continuum including nonsteroidal antiinflammatory drugs (NSAIDs), antidepressants, anticonvulsants, autonomic agents and other medications is described. A place for opioids in this continuum is defined. Barriers to appropriate use of opioids are discussed, including concerns about regulatory sanctions. Tolerance, dependence and addiction are differentiated. The rational use of opioids in nonmalignant pain management is described in the context of interdisciplinary, multimodal care.

Frontiers in Neurology

Since the outbreak of the COVID-19 pandemic, races across academia and industry have been initiat... more Since the outbreak of the COVID-19 pandemic, races across academia and industry have been initiated to identify and develop disease modifying or preventative therapeutic strategies has been initiated. The primary focus has been on pharmacological treatment of the immune and respiratory system and the development of a vaccine. The hyperinflammatory state (“cytokine storm”) observed in many cases of COVID-19 indicates a prognostically negative disease progression that may lead to respiratory distress, multiple organ failure, shock, and death. Many critically ill patients continue to be at risk for significant, long-lasting morbidity or mortality. The human immune and respiratory systems are heavily regulated by the central nervous system, and intervention in the signaling of these neural pathways may permit targeted therapeutic control of excessive inflammation and pulmonary bronchoconstriction. Several technologies, both invasive and non-invasive, are available and approved for clini...

Postgraduate Medicine

ABSTRACT Objective: In the treatment of chronic diseases, remission is commonly used as a meaning... more ABSTRACT Objective: In the treatment of chronic diseases, remission is commonly used as a meaningful treatment goal, synonymous with the absence of significant clinical signs and symptoms of a disease, but not representing a cure. The objective of this paper is to propose a definition for remission for use as an outcome to evaluate the long-term efficacy of therapies for chronic pain. Methods: Data from a randomized clinical trial (NCT01609972) testing the efficacy of spinal cord stimulation in low back and leg pain subjects was used to evaluate the association between pain and functional outcomes and identify the cut-off value to predict remission. Available data over 24-month assessment period included visual analog score (VAS), disability (Oswestry Disability Index [ODI]), patient and clinician global impression of change (PGIC and CGIC), and patient satisfaction. Cluster analysis, Pearson’s correlation coefficients, sensitivity, and specificity analyses were used to evaluate its utility in predicting higher patient functionality and satisfaction. Results: Though the term remission has been used in the chronic pain field, a consistent definition has not been previously established. Based on the analysis of the clinical data, we propose that a sustained (≥6 months) pain score of ≤3.0 cm out of 10 cm on VAS be defined as remission. Applying this definition to the clinical trial data: subjects in remission at 24 months versus non-remitters were significantly more likely to be in the highest functional category of minimally disabled according to the ODI (31.5 vs. 8.2%, respectively, p = 0.001), and be ‘very satisfied’ (75.7 vs 22.6%, respectively, p < 0.001). Conclusions: The validity of the proposed definition of remission is supported by the persistence of remission in this study group, and its correspondence with patient satisfaction, and reduced disability. Further evaluation of the definition using clinical data from other long-term studies is needed. Trial registration: ClinicalTrials.gov identifier: NCT01609972.

Surgical technology international, 1991

There has recently been an increased interest in the safety, efficacy and relative ease in the de... more There has recently been an increased interest in the safety, efficacy and relative ease in the delivery of intraspinal analgesics for the control of intractable pain. Recent technological advances have provided clinicians with precise and accurate delivery systems for long term infusion of spinally administered drugs. Because of these advances, there has been a rapidly growing interest in long term intraspinal infusional therapy for the control of chronic pain.

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease stat... more Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. Th...

Neuromodulation : journal of the International Neuromodulation Society, Jan 2, 2017

Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or per... more Neurostimulation involves the implantation of devices to stimulate the brain, spinal cord, or peripheral or cranial nerves for the purpose of modulating the neural activity of the targeted structures to achieve specific therapeutic effects. Surgical placement of neurostimulation devices is associated with risks of neurologic injury, as well as possible sequelae from the local or systemic effects of the intervention. The goal of the Neurostimulation Appropriateness Consensus Committee (NACC) is to improve the safety of neurostimulation. The International Neuromodulation Society (INS) is dedicated to improving neurostimulation efficacy and patient safety. Over the past two decades the INS has established a process to use best evidence to improve care. This article updates work published by the NACC in 2014. NACC authors were chosen based on nomination to the INS executive board and were selected based on publications, academic acumen, international impact, and diversity. In areas in w...

Neuromodulation, 2006

I have lost a true and great friend. Writing this eulogy for such a man as John Oakley does not b... more I have lost a true and great friend. Writing this eulogy for such a man as John Oakley does not belong to one person, for John Oakley was a friend, a colleague, and a mentor to many from all over our planet. But for me, John was not only a friend and mentor, but also a model of how I want to be perceived in this world. John was a model of DOING, of love, passion, intelligence, quick wit, ethics, loyalty, and caring. John was a human's human. I will miss him terribly. So will his family, his friends, his colleagues, and the wide, wide world in which John chose to participate. John Oakley died at the very tender age of 60 on April 17, 2006. He was born January 11, 1946, in Seattle, Washington. John was the second child of a family of six children. He was the son of and is survived by Donald and Beulah Oakley. He is survived by brothers Robert and Steve and sisters Nancy Manning, Sally Sheehan, and Donna Oakley. John is survived by his wife, Shirley; his sons John, Jr., and Peter; his daughter, Rebekah; and his grandchildren, John Christian, age 9, Alan, age 5, and Anna, just 3 days old. According to his wife, Shirley, whom he married on June 20, 1969, John's first passion was history and religion and he wanted to pursue either a career as a minister in the Lutheran church or a career as a professor of history. John began his college education at the University of Washington in 1964, but finished his college education at Pacific Lutheran University in 1968, where he graduated, magna cum laude. But as many human stories go, and as luck has it for all of us, John did not choose to pursue a career in either the ministry or history; he chose medicine. After medical school training at the University of Washington in Seattle, where he graduated from in 1972, John interned at Cincinnati General Hospital and completed his residency training in neurosurgery at the University of Washington. After completion of his neurosurgical training, John started his career at the National Institutes of Health before becoming a professor of neurosurgery under the tutelage of Phillip Weinstein, chairman of the Department of Neurosurgery at the University of Arizona, where John spent 2 years. After Arizona, John chose to come back to Seattle, Washington, the place of his birth, and spent the next 17 years in the private practice of neurosurgical medicine at Northwestern Hospital in Seattle. John

Pain Reviews, Nov 30, 1995

Neuromodulation and Chronic Pain Theodosiadis P, Samoladas E, Grosomanidis V, Karakoulas K, Vasil... more Neuromodulation and Chronic Pain Theodosiadis P, Samoladas E, Grosomanidis V, Karakoulas K, Vasilakos D Chronic pain causes extreme suffering for millions of people worldwide. It is the leading cause for lost workdays and patients often undergo expensive courses of treatment. Because chronic pain is often difficult to relieve for sustained periods of time, it can have a significant impact on

Acta neurochirurgica. Supplement, 2007

Operative neuromodulation is the field of altering electrically or chemically the signal transmis... more Operative neuromodulation is the field of altering electrically or chemically the signal transmission in the nervous system by implanted devices in order to excite, inhibit or tune the activities of neurons or neural networks and produce therapeutic effects. It is a rapidly evolving biomedical and high-technology field on the cutting-edge of developments across a wide range of scientific disciplines. The authors review relevant literature on the neuromodulation procedures that are performed in the spinal cord or peripheral nerves in order to treat a considerable number of conditions such as (a) chronic pain (craniofacial, somatic, pelvic, limb, or due to failed back surgery), (b) spasticity (due to spinal trauma, multiple sclerosis, upper motor neuron disease, dystonia, cerebral palsy, cerebrovascular disease or head trauma), (c) respiratory disorders, (d) cardiovascular ischemia, (e) neuropathic bladder, and (f) bowel dysfunction of neural cause. Functional neuroprosthetics, a fiel...

Neuromodulation : journal of the International Neuromodulation Society, 2015

In the not-too-distant past, the dorsal root ganglion (DRG) was portrayed as a passive neural str... more In the not-too-distant past, the dorsal root ganglion (DRG) was portrayed as a passive neural structure without involvement in the development or maintenance of chronic neuropathic pain (NP). The DRG was thought of as a structure that merely "supported" physiologic communication between the peripheral nervous system (PNS) and the central nervous system (CNS). Newer scientific information regarding the anatomic and physiologic changes that occur within the DRG as a result of environmental pressures has dispelled this concept and suggests that the DRG is an active participant in the development of NP. This new information, along with new clinical data showing that stimulation of the DRG reduces intensity of pain, suggests that the DRG can be a robust target for neuromodulation therapies. A review of the anatomical and physiological literature regarding the role of the DRG in the development of NP was performed utilizing SciBase, PubMed, and Google Scholar. The information ga...

The journal of supportive oncology

Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and... more Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and their families is staggering. Spinal cord stimulation for the treatment of chronic pain is cost-effective when used in the context of a pain treatment continuum. Many theories on the mechanism of action of spinal cord stimulation have been suggested, including activation of gate control mechanisms, conductance blockade of the spinothalamic tracts, activation of supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms, and activation or release of putative neuromodulators. Whatever theory or theories of mechanism are correct, spinal cord stimulation has efficacy in the treatment of failed back surgery syndrome, complex regional pain syndromes, intractable pain due to peripheral vascular disease, and intractable pain due to angina.