Neurostimulation Techniques for Painful Peripheral Nerve Disorders

Stuart, R. Morgan; Winfree, Christopher J.

doi:10.1016/j.nec.2008.07.027

Cited by 39 publications

(20 citation statements)

References 40 publications

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“…Peripheral nerve stimulation, in which the electrode is placed adjacent to a distinctive peripheral nerve, may be useful in circumscribed pain syndromes along a peripheral nerve distribution [19] while nerve root stimulation has been shown to have marked limitations [20] . Therefore, SPNS may be considered for the treatment of chronic pain in the supraorbital, occipital and inguinal areas, which are not sufficiently amenable to spinal cord or nerve root stimulation [13,[21][22][23][24] . The effect of subcutaneous occipital nerve stimulation has been evaluated for various pain syndromes [21,22,25] .…”

Section: Discussionmentioning

confidence: 99%

“…Like any other surgical technique, SPNS may also fail or cause challenging complications [13] . A complication inherent in all neurostimulation procedures is that of lead displacement, which occurred twice in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Subcutaneous peripheral neurostimulation (SPNS) has recently been implemented as a treatment modality for chronic neuropathic pain when the site of pain cannot be approached by spinal cord or peripheral nerve stimulation [13] . Here, we report the use of SPNS as an innovative therapeutic option in a 42-year-old woman with chronic disabling poststernotomy neuralgia.…”

Section: Introductionmentioning

confidence: 99%

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Subcutaneous Peripheral Neurostimulation for the Treatment of Severe Chronic Poststernotomy Neuralgia

Peyravi¹,

Capelle²,

Fischer

et al. 2011

Stereotact Funct Neurosurg

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Objective:Poststernotomy pain frequently develops after sternotomy in thoracic and cardiovascular surgery, and may affect patients’ quality of life. In some cases of severe poststernotomy neuralgia, pharmacologic therapy does not provide adequate relief. Case Report: We report on a 42- year-old woman who underwent sternotomy for aortic and mitral valve replacement. She developed severe chronic poststernotomy neuralgia that was refractory to medical treatment. After local anesthesia markedly but only transiently alleviated pain, we considered the option of subcutaneous peripheral neurostimulation (SPNS). Plate electrodes were implanted bilaterally in the parasternal region at the site of maximal pain. After a period of test stimulation, the electrodes were connected to a dual-channel implantable pulse generator. SPNS induced paresthesias in the painful area. Revision surgery was necessary twice because of electrode migration. Chronic SPNS markedly alleviated pain (visual-analog scale, VAS, 9/10 preoperatively, 2/10 postoperatively) and allodynia (VAS 9/10 preoperatively, 2/10 postoperatively) at the last available follow-up, 15 months postoperatively. Conclusions: SPNS may be a viable treatment option in patients with severe chronic poststernotomy neuralgia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Subcutaneous Peripheral Neurostimulation for the Treatment of Severe Chronic Poststernotomy Neuralgia

Peyravi¹,

Capelle²,

Fischer

et al. 2011

Stereotact Funct Neurosurg

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“…Surveying online sources, including clinicaltrials.gov, as well as published reviews [5][6][7][8][9], we find a number of compounds targeting novel mechanisms of action in clinical trials (Table 1). These include the major glutamate neurotransmitter receptors-metabotropic, ␣-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid/kainate, and Nmethyl-D-aspartic acid-as well as cannabinoid receptors and transient receptor potential cation channel, subfamily V, member 1 (TRPV1) receptors.…”

Section: Emerging Therapeutic Modalitiesmentioning

confidence: 99%

Future Directions in Neuropathic Pain Therapy: Closing the Translational Loop

Bačkonja

Woolf

2010

The Oncologist

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In the majority of patients, existing therapies for neuropathic pain are far from effective. Furthermore, all current treatments are symptomatic rather than disease-modifying or curative. A range of therapeutic modalities is emerging, targeting a variety of mechanisms, but choosing the best target and evaluating the resulting therapies against the many types of neuropathic pain disorders is not an easy task. In this article, we suggest a shift in emphasis of the drug discovery paradigm toward unbiased evaluation of the particular neurobiological mechanisms contributing to neuropathic pain in individual patients. Genomewide association studies and other discovery science approaches to identify significant novel targets should be given priority as should the development of increasingly sophisticated tools for measuring and categorizing neuropathic pain. The Oncologist 2010; 15(suppl 2):24 -29

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“…Peripheral nerve stimulation has proven benefit in an assembly of neuropathic pain conditions 1,4,26,27 as well as other intractable pain states. 15,21,28 Both PNS and peripheral nerve field stimulation (PNfS) have been shown to be effective treatment modalities for conditions associated with truncal pain, intractable abdominal pain, and fibromyalgia.…”

mentioning

confidence: 99%

Novel technique for trialing peripheral nerve stimulation: ultrasonography-guided StimuCath trial

Reddy¹,

Flouty²,

Holland³

et al. 2017

FOC

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OBJECTIVE Peripheral nerve stimulation (PNS) has been used for the treatment of neuropathic pain for many decades. Despite the specific indications for PNS, clinicians often have difficulty screening for candidates likely to have a good or fair outcome. Given the expense of a permanent implant, most insurance companies will not pay for the implant without a successful PNS trial. And since PNS has only recently been approved by the US Food and Drug Administration, many insurance companies will not pay for a conventional trial of PNS. The objective of this study is to describe a short low-cost method for trialing and screening patients for peripheral nerve stimulator implantation. Additionally, this study demonstrates the long-term efficacy of PNS in the treatment of chronic neuropathic pain and the relative effectiveness of this novel screening method. METHODS The records of all patients who had undergone trialing and implantation of a PNS system for chronic refractory pain at the authors' institution over a 1-year period (August 1, 2012–July 31, 2013) were examined in this retrospective case series. The search revealed 17 patients, 13 who had undergone a novel in-office ultrasonography-guided StimuCath screening technique and 4 who had undergone a traditional week-long screening procedure. All 17 patients experienced a successful PNS trial and proceeded to permanent PNS system implantation. Patients were followed up for a mean duration of 3.0 years. Visual analog scale (VAS) pain scores were used to assess pain relief in the short-term (< 6 weeks), at 1 year, and at the last follow-up. Final outcome was also characterized as good, fair, poor, or bad. RESULTS Of these 17 patients, 10 were still using their stimulator at the last follow-up, with 8 of them obtaining good relief (classified as ≥ 50% pain relief, with an average 81% reduction in the VAS score) and 2 patients attaining fair relief (< 50% relief but still using stimulation therapy). Among the remaining 7 patients, the stimulator had been explanted in 4 and there had been no relief in 3. Excluding explanted cases, follow-up ranged from 14 to 46 months, with an average of 36 months. Patients with good or fair relief had experienced pain prior to implantation for an average of 5.1 years (range 1.8–15.2 years). A longer duration of pain trended toward a poorer outcome (bad outcome 7.6 years vs good outcome 4.1 years, p = 0.03). Seven (54%) of the 13 patients with the shorter trial experienced a good or fair outcome with an average 79% reduction in the VAS score; however, all 4 of the bad outcome cases came from this group. Three (75%) of the 4 patients with the longer trial experienced a good or fair outcome at the last follow-up, with an average 54% reduction in the VAS score. There was no difference between the trialing methods and the proportion of favorable (good or fair) outcomes (p = 0.71). CONCLUSIONS Short, ultrasonography-guided StimuCath trials were feasible in screening patients for permanent implantation of PNS, with efficacy similar to the traditional week-long screening noted at the 3-year follow-up.

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Neurostimulation Techniques for Painful Peripheral Nerve Disorders

Cited by 39 publications

References 40 publications

Subcutaneous Peripheral Neurostimulation for the Treatment of Severe Chronic Poststernotomy Neuralgia

Subcutaneous Peripheral Neurostimulation for the Treatment of Severe Chronic Poststernotomy Neuralgia

Future Directions in Neuropathic Pain Therapy: Closing the Translational Loop

Novel technique for trialing peripheral nerve stimulation: ultrasonography-guided StimuCath trial

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