Lumbar Sympathetic Chain Neuromodulation with Implanted Electrodes for Long-Term Pain Relief in Loin Pain Haematuria Syndrome

A Patient With Loin Hematuria Syndrome and Chronic Flank Pain Treated With Pulsed Radiofrequency of the Splanchnic Nerves

“…12 Hebert et al 13 described the use of angiotensin-converting enzyme inhibitors in the management of LPHS to decrease glomerular hemorrhage and therefore pain. There have been reports of surgical denervation, 14 neurostimulation of the splanchnic nerves, 15 and renal autotransplantation, in which a kidney and the proximal portion of the ureter is completely excised from the patient and then reimplanted into the iliac fossa, thus preserving renal function. 16,17 Autotransplantation is not a guaranteed success in regard to permanent analgesia.…”

Percutaneous Peripheral Neuromodulation Lead Insertion Using a Novel Stimulating Coudé Needle

“…This percutaneous technique of electrode insertion allows minimally invasive placement of stimulating electrodes and enables access to novel areas of stimulation, such as single nerves, previously the exclusive domain of surgery (6,7); the nerve plexus (8); subcutaneous targets/field (9)(10)(11)(12); or the sympathetic chain (13,14). These advantages have led to an increase in its popularity, allowing treatment of chronic pain states either as a standalone treatment or in combination with spinal cord stimulation (15)(16)(17)(18).…”

To Test or Not to Test in Peripheral Nerve Stimulation?

“…There are other simpler and more precise techniques that can be used to this effect. For instance, a regional-anesthesia-based approach to locate the affected nerve with a single needle and a nerve stimulator would allow us to elicit precise paresthesia (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Even this technique might have some limitations.…”

“…Since the authors are striving to reduce the number of patients implanted in vain, we are perplexed by their decision not to include intraoperative testing in their peripheral neuromodulation implant technique. From personal experience, we believe that on-table testing is particularly important for peripheral nerve stimulation (3)(4)(5)(6)(7)(8)(9)(10)(11)(12); this can be complemented by ultrasound-guided placement of leads (13)(14)(15) to achieve optimal position of the stimulating lead. For peripheral neuromodulation in general, incorrect placement of leads may result in inadequate pain relief due to poor coverage, or even in painful and unwanted stimulation (16,17).…”