Comparison of tonic spinal cord stimulation, high-frequency and burst stimulation in patients with complex regional pain syndrome: a double-blind, randomised placebo controlled trial

BACKGROUND: Complex Regional Pain Syndrome (CRPS) is a disabling disease that is sometimes difficult to treat. Although spinal cord stimulation (SCS) can reduce pain in most patients with CRPS, some do not achieve the desired reduction in pain. Moreover, the pain reduction can diminish over time even after an initially successful period of SCS. Pain reduction can be regained by increasing the SCS frequency, but this has not been investigated in a prospective trial. This study compares pain reduction using five SCS frequencies (standard 40 Hz, 500 Hz, 1200 Hz, burst and placebo stimulation) in patients with CRPS to determine which of the modalities is most effective. DESIGN: All patients with a confirmed CRPS diagnosis that have unsuccessfully tried all other therapies and are eligible for SCS, can enroll in this trial (primary implantation group). CRPS patients that already receive SCS therapy, or those previously treated with SCS but with loss of therapeutic effect over time, can also participate (re-implantation group). Once all inclusion criteria are met and written informed consent obtained, patients will undergo a baseline assessment (T0). A 2-week trial with SCS is performed and, if successful, a rechargeable internal pulse generator (IPG) is implanted. For the following 3 months the patient will have standard 40 Hz stimulation therapy before a follow-up assessment (T1) is performed. Those who have completed the T1 assessment will enroll in a 10-week crossover period in which the five SCS frequencies are tested in five periods, each frequency lasting for 2 weeks. At the end of the crossover period, the patient will choose which frequency is to be used for stimulation for an additional 3 months, until the T2 assessment. DISCUSSION: Currently no trials are available that systematically investigate the importance of variation in frequency during SCS in patients with CRPS. Data from this trial will provide better insight as to whether SCS with a higher frequency, or with burst stimulation, results in more effective pain relief. TRIAL REGISTRATION: Current Controlled Trials ISRCTN3665525

New approach for developing warrants of protected left-turn phase at signalized intersections

The research embodied in this paper presents a new approach for the development of guidelines for the installation of a protected left-turn phase at signalized intersections when permissive-only left-turn operation is present. This approach is based on maintaining intersection traffic operation at optimum efficiency. Three analyses were presented and discussed and they involved the use of the new approach on some hypothetical basic scenarios at a four-legged intersection with single lane in each approach. The first scenario involved exclusive left-turn lane operation while the other two scenarios involved shared-lane operation. Exhaustive signal optimization analyses were conducted using a signal optimization software package called "Signal Expert". Regression models were developed from optimization results that allow the analyst to make the decision on protected left-turn phase installation using the basic input data of signal timing design without the need to perform field measurements. The regression results showed that the transition from permissive to protected/permissive left-turn operation, based on system optimization, is mainly a function of traffic conditions and that this transition (interface) is predictable. The results also suggested that these warrants are of reasonable accuracy when compared with those in the current practice.

Decision tree-based model for estimation of work zone capacity

10.3141/2257-05Transportation Research Record225740-50TRRE