Permanent Percutaneous Splanchnic Nerve Neuromodulation for Management of Pain due to Chronic Pancreatitis: A Case Report

Interventional Pain Management Approaches for Control of Chronic Pancreatic Pain

“…Direct stimulation of the splanchnic nerves is one of the options [37], or even direct stimulation of dorsal root ganglia at appropriate dermatomal level [38] could be tried in the future. As we are completing this book chapter, a European study on dorsal root ganglia stimulation for control of the pain from chronic pancreatitis was initiated.…”

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).…”